The good news is that health plans reporting to the National Committee for Quality Assurance improved in most areas in 2004. The bad news is that fewer Americans are benefiting from those improvements.
In its annual report on the quality of healthcare among health plans, released on Oct. 3, the NCQA found the average plan's performance improved in 18 of 22 measures. For the sixth year in a row, people covered in plans that measure and report performance more often received appropriate preventive care and treatment for chronic diseases.
However, it also found that 64.5 million Americans were covered by the 289 health plans that publicly reported their data to the NCQA, down 4.5 million, or 6.5%, compared with 2003. The decline in coverage, according to the report, is because of an increase in enrollment in PPOs and health savings accounts, which tend not to report on quality performance
As interest in consumer-driven plans increases, the findings caused concern among some in the industry, who said the trend can only hurt patients. "This shift in enrollment means that consumers have less and less information to guide their healthcare decisions," said Margaret O'Kane, president and chief executive officer of the NCQA. "It also may mean that in the future there will be less of an incentive for health plans to improve."
The issue is that in plans such as HSAs and PPOs, consumers have greater freedom to choose their providers but may be left on their own to determine which ones are best for their needs. Without quality information about and from such plans, the fear is that patients may end up making the wrong choices.
"The irony is that consumers who are paying out of pocket have greater needs and greater desire for information because the money is coming out of their pockets," said Kenneth Kizer, president and CEO of the National Quality Forum.
Supporters of plans such as HSAs said that because they force patients to become better healthcare shoppers, they will lower healthcare costs. Last week, those supporters said that the NCQA's finding that 4.5 million fewer patients were covered by managed-care plans reporting to the NCQA confirms that more patients are growing dissatisfied with such plans.
Michael Cannon, director of health policy studies at the Cato Institute, a conservative Washington think tank, warned against reading too much into the lack of reporting by HSAs because such plans are still new and thus have low market penetration. According to a recent study by the Kaiser Family Foundation and the Health Research & Educational Trust, just 1.2% of employees were in HSAs this year. "The fact that they aren't reporting now doesn't mean they won't in the future," Cannon said.
-with Joseph Conn