NCQA: State of managed care keeps getting better
NCQA: State of managed care keeps getting better
NCQA report shows gains in health plan care
The latest report on managed care quality from the National Committee for Quality Assurance (NCQA) shows that health plans continue to improve the quality of care they deliver to patients. The fifth annual State of Managed Care Quality report showed significant gains in key areas of care and service.
The report states: "The national averages for nearly every clinical measure tracked by NCQA improved in 2000, in some cases by more than five percentage points. The national averages for nearly all member satisfaction measures improved as well."
The report’s authors say data-collection methodologies are at the heart of the gains. "Health plans tend to score higher on [Health Plan Employer Data and Information Set (HEDIS)] measures when they do a better job of capturing data to track their performance."
According to the report, health plans are demonstrating increased success in delivering services aimed at controlling or preventing disease. Among reporting plans, the average rate of patients receiving cholesterol screening after a cardiovascular event such as a heart attack rose from 69% in 1999, to 74% in 2000.
Adequate cholesterol screenings, as part of a complete cholesterol reduction program, can help reduce morbidity and mortality from a heart attack or stroke by as much as 40%. In addition, the rate at which diabetic members of reporting plans received an annual retinal exam increased from 45% to 48%; retinal exams can lead to better management of the disease, thus preventing such complications as blindness and amputations.
The degree of variation between plans is continuing to close, as plans that have performed poorly in the past have again registered impressive gains. For plans performing in the 10th percentile, the average rate of cholesterol screenings jumped 10 percentage points, from 53% in 1999 to 63% in 2000, while 90th percentile averages increased from 83% to 85%.
The 10th percentile average for childhood varicella (chicken pox) immunizations showed a similar increase, from 50% to 58%, helping to spur a seven-percentage-point increase in the overall average, which rose from 64% in 1999, to 71% in 2000.
For the first time, the report also includes information on the economics of quality care. Designed primarily for employers and purchasers of health care, that portion of the report includes data on the cost of various illnesses in days of labor lost and compares it to the cost of treatment or prevention.
Working together works wonders
Among the health plans reporting impressive results and strong improvement in their HEDIS measures this year were Anthem Blue Cross Blue Shield plans. "When you watch a health plan’s HEDIS results increase from year to year, that plan has done a good job of developing a collaborative relationship with its physicians and members," says Sam Nussbaum, MD, executive vice president and chief medical officer, Anthem Blue Cross Blue Shield (Indianapolis). "Health plans that work with their physicians, hospitals and members can raise the bar dramatically on quality. We are proud to have established that kind of culture at Anthem."
Another key finding is that plans recorded their highest performance gains in newer measures, such as cholesterol control rates and controlling high blood pressure, evidence that plans that engage in measurement and reporting are devoting greater attention and resources to important areas of care. Rates for cholesterol control rose from 45% in 1999, to 53% in 2000, and average rates for controlling high blood pressure jumped 13 percentage points in 2000, from 39% to 52%. Health plans made similar progress in diabetes care.
The average rate of diabetics screened for LDL cholesterol increased by eight percentage points, from 69% in 1999, to 77% in 2000. The rate of diabetics who had properly controlled LDL cholesterol rose from 37% to 44%. The average rate of diabetics monitored for kidney disease gained five percentage points (36% to 41%).
An interesting finding, in the face of the ongoing debate on a Patients’ Bill of Rights, is that average rates for key indicators of member satisfaction are also rising. The percentage of members who rated their health plan 8, 9, or 10 out of a possible 10 increased from 57% in 1999, to 59% in 2000. Members demonstrated a similar increase in satisfaction with customer service, as 67% said they did not encounter problems in obtaining plan information, getting help, or completing paperwork (up from 65% in 1999).
The bad news
But it isn’t all good news. The report indicates that there are still plans to improve. "With respect to chlamydia screening rates and mental health care, performance is, respectively, below acceptable levels and failing to show signs of improvement."
Chlamydia screening rates increased by about 5% between 1999 and 2000, but the report notes that only about a quarter of the women who should be screened are. "Chlamydia is the most prevalent sexually transmitted disease in the U.S., affecting some 3 million women annually. Screenings are a cost-effective way to avoid the serious complications associated with chlamydia such as ectopic pregnancy and infertility."
And just under 50% of patients received recommended follow-up visits within seven days of being discharged from an inpatient mental health facility, the report notes. "Only 71% received such visits within 30 days. Perhaps more disturbingly, these rates failed to improve appreciably in 2000. Improving the treatment of mental illness is a critical issue in the United States, where nearly 40 million people suffer from some form of mental illness during the course of a given year. The annual costs associated with depression alone are estimated to be at least $40 billion."
On the positive side, the report notes that increased collaboration across different levels of the health care system are paying off in spades with the plans that improved most. Another winning strategy is disease management initiatives. "But there remain areas of concern — mental health care, in particular, remains an obvious target for more focused improvement efforts."
Selected Results from 2000 State of Managed Care Quality
Measure National Average Adolescent Immunizations: MMR................................................................... 62.3% Hepatitis B.......................................................... 41.1% VZV .................................................................... 28.5%Asthma Medication Use:
Ages 18-56.........................................................
64.4% Beta Blocker Treatment after Heart Attack.............................................. 89.4%Breast Cancer Screening
74.5%Cervical Cancer Screening
78.1%Childhood Immunization:
DTP.....................................................................
0.4%OPV......................................................................
84.2%MMR .................................................................
88.4%HiB ......................................................................
82.7%Hepatitis B..........................................................
77.9%VZV......................................................................
70.5%Cholesterol Management:
Screening............................................................
74.2%Control.................................................................
53.4%Claims Processing
80.8%Comprehensive Diabetes Care:
Eye Exams...........................................................
40.8% Lipid Profile........................................................ 76.5%Lipid Control...................................................
44.3%HbA1c Testing..................................................
78.4%Poor HbA1c Control.........................................
42.5%Courteous Office Staff....................................
91.3%Customer Service ............................................
66.6%Follow-up after Mental Illness:
7 days.................................................................
48.2%Getting Care Quickly ....................................
78.3%Getting Needed Care.......................................
75.4% Source: National Committee for Quality Assurance, Washington, D.C.[For more information, contact:
Sam Nussbaum, MD, Executive Vice President and Medical Director, Anthem, 120 Monument Circle, Indianapolis, IN 46204. Telephone: (317) 488-6111.
For more on the report, to view an on-line version, or to order a hard copy, visit NCQA at www.ncqa.org.]
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