The quality of care delivered to patients enrolled in health plans that submit data to the National Committee for Quality Assurance has improved for the ninth straight year, according to a report released by the NCQA. But federal payers, such as Medicare and Medicaid, continue to lag behind commercial payers.
Commercial plans that submitted Healthcare Effectiveness Data and Information Set, or HEDIS, material showed increases on 44 of 54 quality measures, including asthma medication management, blood pressure control and postpartum care for infants. Private plans in Medicare also posted gains, especially in the treatment after heart attacks and medication management. In contrast, traditional Medicare plans showed improvement on only 24 of 45 measures; and Medicaid on 26 of 52.
"When it comes to quality, our current system is all over the map," said NCQA President Margaret OKane. "It not only harms people's health, but it wastes billions of dollars. We know that when we measure performance, improvement follows."
The NCQA accredits and measures health plansand by extension the providers who practice within themon a list of clinical measures that track how often the appropriate care, based on medical evidence, is delivered. Those measures make up the HEDIS benchmarks. Almost half, 45%, of the estimated 202 million Americans in the commercial insurance market are enrolled in plans that consistently measure quality and report results to the NCQA, the report states. The data, which was tracked over 2007 and drawn from 845 plans, included 605 HMO submissions and 240 from PPOs. -- by Matthew DoBias