Managed Care Medicare, Medicaid and Private Plans Show Quality of Care Improvement
Health care quality for millions of U.S. residents insured through managed care Medicare, Medicaid or commercial plans has improved substantially, according to a new National Committee for Quality Assurance report (NCQA release, 9/18). The annual report, called the "State of Health Care Quality," examined the performance of 271 managed care plans that voluntarily submitted information on quality of care, access to care and member satisfaction. Plans that volunteered such information for the report cover about 28% of insured Americans, or about 71 million people (Norris, Detroit Free Press, 9/19). Overall, the study found a "slow by steady improvement in the quality of care being delivered to Americans" enrolled in the participating managed care organizations (Frommer, AP/Contra Costa Times, 9/19). Many commercial managed care plans reported "substantial gains" on several clinical measures. For example, the percentage of patients in commercial plans who were successfully controlling their high blood pressure improved from 51.5% in 2000 to 55.4% last year. For patients with cholesterol, 59.3% of managed care patients who have had a heart attack had their condition under control last year, up nearly six percentage points from 2000 (NCQA release, 9/18). The report named Appleton, Wis.-based Touchpoint Health Plan the "highest performing health plan in the nation overall," as it set "national benchmarks" for ensuring its patients received eye exams, breast cancer screenings and beta blocker treatments after heart attacks. "We worked with the nurses and office staffs to develop processes that would ensure that patients were getting the care they needed," Touchstone President Jay Fulkerson said (Manning, Milwaukee Journal Sentinel, 9/18).
The report studied Medicare and Medicaid managed care plans for the first time and found the care received in those programs is comparable to care delivered through the commercial market. Medicaid and Medicare MCOs "outperformed" commercial plans in several measures. In 2000, 37.4% of women ages 16 to 20 received screening for chlamydia, compared with 23.6% of women enrolled in commercial managed care plans. In 2000, Medicare managed care plans scored higher than commercial health plans on every measure of diabetes care. The report also found a "considerable difference" between NCQA-accredited and nonaccredited Medicare plans. For example, 57.8% of heart attack patients enrolled in NCQA-accredited Medicare plans had their cholesterol levels successfully under control, compared to 44.1% in non-accredited Medicare plans (NCQA release, 9/18).
Despite the improvements, more than 6,000 deaths and 22 million sick days could be prevented if "best practices" were implemented universally, according to the report (Frommer, AP/Arkansas Democrat Gazette, 9/19). The report also noted that "more efficient and productive" health plans can cut costs by "emphasizing preventive medicine" (AP/Contra Costa Times, 9/19). NCQA President Margaret O'Kane said, "We have work to do -- a large part of the health care system still doesn't measure anything." Mohit Ghose, a spokesperson for the American Association of Health Plans, said, "If everybody in the entire industry reported the data, maybe we'd get there a lot sooner" (AP/Arkansas Democrat-Gazette, 9/19). The report is available online. Note: You will need Adobe Acrobat to view the report.This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.