‘Quality Gaps’ at Health Plans Lead to 79,000 Avoidable Deaths Annually, NCQA Report Says
As many as 79,000 avoidable deaths occur annually as a result of "quality gaps" in the care provided by health plans nationwide, despite the fifth consecutive year of improvement, according to a National Committee for Quality Assurance study released on Thursday, the Wall Street Journal reports. In the study, researchers examined health data for 2004 from about 69 million members of 563 health plans that publicly report performance information; about 75% of U.S. residents are enrolled in plans that do not voluntarily provide such information (Rundle, Wall Street Journal, 9/23). The results of the study are based on more than 40 categories of care that NCQA considers indicators of quality. The study found:
- Health plan performance on average improved by four percentage points or more for several categories of care, such as high blood pressure treatment, cholesterol management, vaccinations for children and medication for asthma patients;
- Medicare beneficiaries received appropriate care for cholesterol management 67% of the time, which marked the third consecutive year of improvement;
- Medicaid plans "improved steadily" in the provision of cardiac and diabetes treatment and cancer tests;
- About 67% of health plan members ages 65 and older received the flu vaccine, compared with 84% of those enrolled in the health plans with the highest performance levels;
- The U.S. health care system spent about $1.8 billion in 2003 on avoidable medical costs as a result of failures to provide "more constant delivery of best-practice care"; and
- Avoidable lost productivity as a result of inadequate care costs the U.S. workforce about $9 billion annually.
The study found a "substantial gap" in the quality of care provided by health plans with the highest performance levels and the national average, the AP/Sun reports (Sherman, AP/Las Vegas Sun, 9/23). The study defined quality gaps as the difference between health plans in the top 10% for performance with the national average in different categories of care (Wall Street Journal, 9/23). The study said, "Patients get the correct care only about 50% of the time" (AP/Las Vegas Sun, 9/23).
The study also found that health plans and physicians in New England and Wisconsin "consistently perform better than other areas in delivering needed care." Nine of the top 10 health plans for performance are located in New England or Wisconsin, with the other located in Colorado, the study found. However, according to the study, socioeconomic and geographic factors "cannot explain the variations completely, and it is hard to understand why patients in a few states receive such vastly better care than those in the majority of the country" (Hartford Courant, 9/23).
NCQA President Margaret O'Kane said, "The data we have tell a great story, health care quality is improving consistently and dramatically. Why don't we have performance data for the other 75% of the U.S. health care system?" She added that the improvements in the quality of care provided by health plans "were the biggest year-over-year since we've been publicly reporting." O'Kane said, "We worry quite a bit that the (quality) gains that have been made will be lost" as more consumers move into preferred provider organization plans, which do not participate in the NCQA study (Wall Street Journal, 9/23).
Peter Lee, CEO of Pacific Business Group on Health, said, "This report underscores that all too often we are not getting good value for that money" (AP/Las Vegas Sun, 9/23). CMS Administrator Mark McClellan said in a statement, "Measuring performance allow us to do three very important things: inform consumer choice, reward quality and identify opportunities for improvement. There is enormous potential in these activities to drive improvement and without measurement you can't do any of them. Medicare is 100% committed to pay-for-performance" (NCQA release, 9/23). The study is available online. Note: You must have Adobe Acrobat reader to view the study.
In related news, officials for Cigna on Thursday plan to announce that the company in 2006 will become the first national health insurer to report performance information voluntarily (Hartford Courant, 9/23). Cigna Senior Vice President and Chief Clinical Officer Allen Schaffer said, "Our philosophy is that there should be a single standard of care and medical management across all products" (Wall Street Journal, 9/23).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.