Health plan quality improvement has stalled, new figures show, with commercial plans faring better than their government counterparts, according to the National Committee for Quality Assurance's 13th annual State of Health Care Quality 2009 report.
Medicaid, Medicare, commercial payers had little quality change: report
There was no statistically significant improvement on 57% of quality measures for commercial plans, or on 64% of quality measures for Medicaid. Medicare did the worst, with 86% of quality measures showing no improvement, according to the report.
The slowdown in the quality of care delivered to patients enrolled in health plans comes after 10 years of improvement, said Margaret O'Kane, president of NCQA, which accredits health plans. O'Kane called the results disappointing. “We're surrounded by a lot of opportunity.”
The report studies quality data submitted by 979 health plans, covering 116 million patients. The data are based on the quality association's measures known as the Healthcare Effectiveness Data and Information Set, or HEDIS. Overall, health plans are still not doing enough in quality measures that help monitor patients on antidepressants, follow-up with patients hospitalized for mental illness, initiate treatment for alcohol and drug dependency, or screen for cancer, according to the report. Plans fared better in quality measures that ensure patients received beta-blockers after a heart attack, treat asthma and foster smoking cessation.
This is the third year in a row public plans have lagged in quality performance, according to the report. O'Kane said the results are “a message to the federal government.” More needs to be done, especially because Medicaid and Medicare enrollment have been increasing as more people are unemployed and as the baby boomer population gets older, she said.
There are small pockets of private groups that can drive quality efforts among commercial plans, she said. The federal plans need to do more to encourage initiatives that provide incentives for better quality. “There should be a lot of federal leadership around the quality initiatives. It's not a good thing that the public sector is lagging,” O'Kane said.
Despite the quality lag, the NCQA report shows that patients highly rate their Medicaid plans. In 2008, 72.8% of Medicaid beneficiaries gave their plan an 8, 9 or 10 on the question of “best health plan possible” in the Consumer Assessment of Healthcare Providers and Systems patient survey.
In the same year, 64.3% of patients covered by private plans gave their plans the same rating. Medicare patient-satisfaction data were not available by the publication of the report; NCQA said it will release that data in an updated report later this year.
The NCQA report also included results of a measure it created in 2006 to look at utilization. The Relative Resource Use measure looks at spending in six areas of care including diabetes, cardiovascular disease and lower back pain.
Data from that measure show that higher spending by health plans was not tied to higher quality, according to the report. The NCQA hopes plans can use the broad information from the relative resource use measure to drill into detailed data on health services and see where they can improve, O'Kane said.
One way to start to improve is to create Accountability Care Organizations, according to the NCQA. These organizations go beyond the medical-home model. Where medical homes focus on care coordination with primary-care physicians, ACOs would also include specialists and hospitals, to create more comprehensive delivery systems, O'Kane said.
Quality provisions that are part of the reform bills currently being discussed in Washington include the support of ACOs. O'Kane said the bill provisions are a good step, but said reform is just the “platform, not the end of the discussion.”
Insurers remain committed to quality measuring and reporting, according to America's Health Insurance Plans. The lobbying organization released a written statement in response to the NCQA report. “During the past decade, the focus has been primarily on health plans, there has been little reporting and little call for it outside of our community, and there has been virtually no attention paid to the public reporting on fee-for-service practice.
Experts in the field understand that without accountability from all segments of healthcare, there will be limits to what can be achieved in the quality realm,” AHIP's statement read.
Fostering greater collaboration among health plans will help reporting initiatives, said Christie Travis, CEO of Memphis Business Group on Health. “We expect our plans to work together,” Travis said during the conference. The business group is working with three commercial health plans to aggregate patient data in Tennessee and evaluate it for improvement targets, she said.
In western New York, joint efforts among providers and Excellus Blue Cross and Blue Shield have led to better care, according to Martin Lustick, a physician who is senior vice president and corporate medical director for the health plan. Excellus conducts utilization and disease-management initiatives with providers that have improved coordination of care, said Lustick, who also spoke during the conference.
The projects have given real-time tools that doctors can use in their offices. “It really is an enormously powerful thing for us to get together and collaborate,” he said.
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