Hospital Buyer

A recent report from the National Committee on Quality Assurance (NCQA) noted that an increasing number of patients are receiving care in accordance with standard protocols. This finding was a part of the agency’s State of Health Care Quality 2007 report published at the end of September.

NCQA announced such in their recent report, which rated over 750 different health insurance plans across the country. The organizations that provide coverage for the insured improved, overall, during 2006. However, the improvements during last year were smaller than those seen in previous years.

The report detailed the improvements of commercial health insurers in 30 of the 44 areas of care quality measured. Among the improvements, important strides were made to increasing both the rate of children with up to date immunizations and participants undergoing screening for colorectal cancer. Medicare programs also had improvements noted, in 34 of the 43 quality areas examined.

For the second year in a row, plans that participated in Medicare managed care had lower levels of improvement. Those plans improved only in one third of quality measures assessed. Importantly, there was a significant increase in the number of Medicare managed care plans that participated in the NCQA effort; their compliance with improvement efforts may be lagging behind other programs with a longer history of participation in the NCQA effort.

Significant gains were made in the area of cardiac care, particularly with respect to treating patients who had a heart attack. The number of patients who received standard treatment with a beta blocker at the time of the MI is nearing 100 percent, with consistency across numerous different plans. Eleven years ago, that rate was only 62 percent. A new measure being evaluating is whether patients were continuing with treatment six months after the initial MI. The level of such during 2006 was almost three quarters of the plans.

For the 80 million Americans who participate in plans that are reviewed by NCQA, the overall news from the report is promising. Insurers appear to be making strides in the implementation of efforts to improve overall program quality and cooperating with healthcare providers. A concerning note, however, is that 100 million Americans have health insurance coverage with programming that is not assessed by an external source, such as NCQA, to evaluate safety and quality.

There are gaps within the healthcare system with insurer performance. The top ten percent of performers save significant costs compared to the ninety percent below. If all programs were modeled after those highly effective and efficient programs, cost savings could reach $7.4 billion. Significant gains would also be made with respect to productivity. Also, between 35,000 and 75,000 deaths could be avoided on an annual basis. The possibility to achieve these goals is highlighted by the improvements, described above, in cardiac care.

This is the eleventh consecutive year that NCQA has released this report to the public. This was the first year that PPO health plans participated, a total of 141 voluntarily provided data for the effort.

September 28, 2007 Related topics: Trends, Quality, Safety, Errors