Health Plan Members Do Not Receive Proper Care in Many Cases, Study Finds

Although quality of care in managed care plans is improving, more than 57,000 people in the United States die needlessly each year because they do not receive appropriate care, according to a study released last week by the not-for-profit National Committee for Quality Assurance, the Wall Street Journal reports (Rundle, Wall Street Journal, 9/18). The study rated 513 health plans with more than 71 million members based on performance in delivering 13 health services, including immunizations, breast and cervical cancer screenings, blood pressure control, cholesterol management and diabetes care. The 13 areas are those in which there are known effective treatments, the Detroit Free Press reports (Norris, Detroit Free Press, 9/18). NCQA collected data directly from health plans for the study. According to the study, there are "enormous variations" in health plans' rates of delivering the most-effective treatments or services, the Journal reports. The study notes that about 40% of people who have high blood pressure nationwide have their condition adequately controlled, and it states that increasing the percentage to 68% could mean about 28,000 fewer people would die next year. Failure by the health system to provide the best treatment for asthma, depression, diabetes, heart disease and high blood pressure results in U.S. workers taking 41 million sick days per year, at a loss of $11.5 billion per year to U.S. businesses, the study says. Not providing the best treatments costs the United States more than $1 billion per year in avoidable health care bills, according to the study (Wall Street Journal, 9/18). According to NCQA, doctors and hospitals are discouraged from using new treatments because of poor use of health care technology and health plans' payment systems (Bloomberg/Hartford Courant, 9/19). The study says Appleton, Wis.-based Touchpoint Health Plan is the strongest-performing health plan overall in terms of quality of care. Further, the study finds that health plans in the northeastern United States outperformed those in other regions, a similar finding to previous years.

According to the Journal, the study highlights that "it takes much too long for information about the best ways to detect and treat disease to become part of the standard practice of medicine" (Wall Street Journal, 9/18). NCQA President Margaret O'Kane said, "It's not a question of knowing how to treat heart disease, diabetes or mental illness. We're literally dying, waiting for the practice of medicine to catch up with medical knowledge" (Bloomberg/Hartford Courant, 9/19). The study is available online. Note: You will need Adobe Acrobat Reader to view the report.