Health plans made little or no progress from 1996 to 1997 in all but one of the quality measures tracked by the Health Plan Employer Data and Information Set (HEDIS), according to a report released last week by the National Committee for Quality Assurance.
Also last week, the National Coalition on Health Care released a report on various quality-of-care initiatives. The report, by Donald Berwick, M.D., president of the Institute for Healthcare Quality, argues that case-by-case improvements have not yet brought what's needed to American healthcare: "a breakthrough example of system-level performance of unprecedented quality at affordable cost," such as the improvements Toyota and Japanese manufacturers brought to American industry in the 1980s.
The "Quality Compass 1998" covered 1997 and was the NCQA's second report on the quality of HMOs. The report found improvements of less than 1% in a number of quality measures. However, only one-"advice from a physician to quit smoking"-showed a statistically significant increase, rising from 61% of plans in 1996 to 64% in 1997.
Plans that reported performance data for two consecutive years did make improvements in a number of measurement areas and outperformed the industry as a whole.
"This is less a measure of a point in time than over a period of time, and this shows that the act of reporting achieves improvement in performance," said Susan Pisano, a spokeswoman for the American Association of Health Plans.
The study included data from 447 health plans, about half the total number of plans, said NCQA President Margaret O'Kane. Because many of the largest plans participated, the data covered about 65 million people-about 75% of the total HMO population. But of the 447 plans that submitted data, only 292, representing about 40 million people, allowed their data to be published.
Of the 329 plans that allowed their 1996 data to be published last year, 158 declined to publish their data for 1997. This year 121 plans allowed their data to be published for the first time.
"Some of the plans that were at the bottom of the list thought it really hurt their performance in the marketplace," and thus declined to have their data published, O'Kane said.
The National Coalition on Health Care, an organization representing providers, labor and business, is trying to deflect attention from managed-care abuses and instead increase awareness of other innovations in quality and service. The coalition wants to broaden the base of businesses, consumer groups and lawmakers who understand and push for quality improvement, said Steven Findlay, a spokesman for the group.
The coalition's 22-page summary report on quality innovations in healthcare will be distributed to the nation's 500 largest hospitals.