Medicares controversial managed-care plans, known as Medicare Advantage, appear to be lagging behind other healthcare plans on quality measures, the National Committee for Quality Assurance reported last week.
In its analysis of 2006 data from 767 plans representing 80 million Americans, Medicare managed-care plans for the second year in a row showed little progress, improving in only seven of 21 measures, according to the NCQA, a not-for-profit research group.
At a news conference, NCQA President Margaret OKane said the addition of 44 new Medicare managed-care organizations to the reporting system may account for the lag in improvement, although its too early for us to tell, she said.
By contrast, the NCQA noted considerable quality gains in Medicaid, which improved on 34 of 43 clinical measures set by the Healthcare Effectiveness Data and Information Set, or HEDIS, a tool created by the NCQA to collect data on quality of care and services provided by health plans. Commercial plans improved on 30 of 44 clinical measures, the eighth straight year of improvement for these plans, which made important gains in childhood immunizations and colorectal cancer screening, the report found.
The findings on managed care come amid a congressional fight over funding the managed-care Medicare Advantage plans that some deem to be too expensive relative to traditional Medicare. The CMS just gave the green light for insurers to again market a fast-growing type of Medicare managed-care plan (See story, p. 14).
With all of the money that has been invested in Medicare managed care, it is a concern that these plans arent scoring better on quality, said Leighton Ku, senior fellow with the Center on Budget and Policy Priorities. He noted though that typically when new plans start reporting quality data their information isnt complete yet, and that could lead to lower scores.
The gains that Medicaid has made are encouraging, considering that both Medicaid and the State Childrens Health Insurance Program have been under attack for being inferior, Ku said. Yet, the data show that in many areas, Medicaid performance is comparable to or even better than commercial plans.
The healthcare system still has room for improvement, OKane said. More than 100 million insured Americans remain in health plans that do not report quality performance data, the report found. The report estimates that 35,000 to 75,000 deaths per year could be avoided if the entire system performed as well as the top 10% of accountable healthcare plans. Such improvements could eliminate 45 million sick days and $7.4 billion in lost productivity, the report estimated.
Public reporting of quality metrics of all parts of the healthcare sector is very important, said Mohit Ghose, spokesman for Americas Health Insurance Plans, in an interview. Although plans continue to strive for improvement, the next step should be to establish transparency across the rest of system, beyond the health plans and in the hospitals and among physicians, he said.
In a related development, hospitals have taken a pledge to report on and waive costs for never eventsrare but preventable medical errors. The Leapfrog Hospital Quality and Safety Survey, a national hospital quality rating tool, reported last week that more than half of the 1,285 hospitals that report to the group said they wont bill for a never event. In addition, these hospitals would report the event to the Joint Commission and other agencies, perform a root cause analysis, and apologize to the patient and/or family affected by the event.
Rewarding good performance at all levels in the healthcare system and promoting pay-for-performance initiatives would help improve quality, OKane said, citing one of the NCQAs recommendations.
Such initiatives need to be implemented carefully, said Ann OMalley, a physician-researcher with the Center for Studying Health System Change. We do not want our measurement system to discourage physicians and hospitals from caring for the sicker patients, or for providing particular services needed by particularly complex patients, just so they look good on their HEDIS scores, OMalley said.