From controlling high blood pressure to immunizing children against chicken pox, managed care companies showed a second straight year of improvement in quality measures, according to the fifth annual State of Managed Care Quality report.
Released Sept. 6 by the National Committee for Quality Assurance, the report is based on 372 health plan products covering 63 million HMO enrollees in 2000, according to the group's president, Margaret O'Kane.
NCQA is a not-for-profit organization that accredits managed care plans. It has issued report cards on those plans since 1995.
The most improved among all the quality measures tracked was the hypertension control rate, which jumped from 39% to 52% overall. The 13-percentage-point difference translates to around 250,000 more people having their blood pressure controlled in 2000 than in 1999, according to the report.
Other significant improvements occurred in the areas of the beta blocker treatment rate and all diabetes care measures. Cholesterol screening and control improvements translated to 5,000 more people screened, 7,200 more people getting their cholesterol counts under control and 250 second heart attacks avoided.
In addition, "We found a declining performance gap . . . between the less well-performing plans and the highest-performing plans," O'Kane said in the committee's first-ever Webcast of the report, hosted by the Kaiser Family Foundation. "That is, performance is getting uniformly much better."
Many of the Health Plan Employer Data and Information Set (HEDIS) measures, which the NCQA uses as the basis for its reports, show a declining performance spread between 1996 and 2000.
Beta blocker use after a heart attack, for example, has gone up for both the highest- and lowest-performing HMOs, but more remarkably for the bottom tier, closing the gap dramatically (see chart).
However, chlamydia screening and mental healthcare remain areas of weakness. The structure of the mental health field, including the confidentiality issues involved, has caused its measures to remain stubbornly in place from 1996 to 2000, O'Kane said. Chlamydia screening measures also haven't responded well, she said, perhaps because minors who don't want their parents to know they are on birth control pills are going outside normal health system channels for treatment.
Coordination of care for these particular patients and the overall care provided by HMOs is affected by the cultural issues involved, according to O'Kane, creating "a unique set of circumstances that really requires a unique strategy that we haven't figured out yet."
New this year, the report's "Business Case for Health Care Quality" section emphasizes that employers' "efforts to promote healthcare quality, and their willingness to pay for it, are among their best investments."
The report says there is a "rapidly growing body of research into the direct and indirect costs of morbidity and mortality."
This research includes the HEDIS measures combined with epidemiological data, studies of clinical efficacy and general population statistics.
Capitalizing on this wealth of data, NCQA is developing modeling software to calculate the direct and indirect cost implications of selecting high-quality vs. low-quality healthcare, the report says. NCQA plans to unveil the software this month.
"Using this model, employers will be able to compare the savings in terms of productivity and sick wages avoided that accrue from choosing a high quality (accredited) health plan as opposed to a lower quality plan," the report states.
In summary, says O'Kane, "I think measurement and accreditation--public reporting--drive improvement, improvement saves lives, and improvement saves money."