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CCH® BENEFITS — 11/02/09

Quality Improvement In Health Care Stagnates, Says NCQA Annual Report

From Spencer’s Benefits Reports: The 2009 State of Health Care Quality Report from the National Committee for Quality Assurance (NCQA)reveals that after 10 years of quality improvement, “the quality of care in America appears to have reached a plateau.” The report noted that “With a few key exceptions, quality measures in the three major sectors of our system — commercial insurance, Medicare, and Medicaid — were flat.”

Richard Sorian, vice president of public policy with NCQA, attributed the slowing performance of health plans to the economy and the pay-for-service model. “In many cases employers and health plans have taken their eye off quality to focus on cost-cutting,” Mr. Sorian said, adding that the health industry’s pay-for-service model does not create an incentive to improve the quality of care.

Improving health care quality would have significant benefits beyond the health care system itself, according to NCQA. The organization estimates that were all health plans able to perform at the level of the top 10% of plans, the U.S. would avoid up to 115,000 thousand deaths and save at least $12 billion in medical costs and lost productivity every year.

NCQA’s report examines quality data submitted by 979 health plans across the country that collectively cover 116 million Americans. The 13th annual report noted several key areas of care have seen little progress in several years, including these:

• Only 46.4% of people taking anti-depressant drugs are monitored by their physicians;
• 34.1% of children prescribed medications for attention deficit hyperactivity disorder (ADHD) are seeing a doctor for follow-up care;
• Half of patients previously hospitalized for mental illness see a physician for a follow-up visit;
• 45.3% of people are receiving colon cancer screening at the appropriate age; and
• Only 42.6% of patients with alcohol or drug dependency are entering into treatment.

In addition, for the third year in a row, NCQA found that the performance of health plans serving Medicare and Medicaid patients failed to appreciably improve on key quality measures. Among Medicare Advantage plans, only 5 of 36 measures (14%) showed a statistically significant improvement; in Medicaid, 18 of 50 measures (36%) showed a statistically significant gain, and most of these improvements were small.

While the data show that the system has hit a performance plateau, these improvements were noted:

• A 12 percentage point jump in the provision of beta-blocker drugs to Medicare patients who had a heart attack within the previous 6 months. Provision of these drugs greatly reduces the possibility of a second, often fatal, attack.
• Near universal high-quality care for Americans with asthma. An estimated 30 million Americans have asthma.
• Substantial gains in helping Medicaid beneficiaries stop smoking; 1 in 3 Medicaid beneficiaries in health plans are smokers.

“As Congress works to shape a final health reform bill, lawmakers must be certain that the legislation includes significant provisions to improve the quality and efficiency of care,” said NCQA President Margaret E. O’Kane. “This includes requiring quality reporting by all health plans and providers, not just those who do so voluntarily today.”

Regarding health reform, the NCQA report recommends the following elements be included in any health reform legislation:

• Create insurance exchanges and require participating plans to maintain accreditation that assesses clinical quality
• Reform payment and delivery systems to reward quality performance and spur care coordination.
• Focus on quality improvement in Medicare and Medicaid.

For more information, visit http://www.ncqa.org/sohc.

For more information on this and related topics, consult the CCH Pension Plan Guide, CCH Employee Benefits Management, and Spencer's Benefits Reports.

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