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Quality in 2009: Stuck in Neutral?

Janice Simmons, for HealthLeaders Media, October 22, 2009

For the dozen years that the National Committee for Quality Assurance (NCQA) has been compiling its annual State of Health Care Quality report, "there's never been a more opportune time" to present this report, said NCQA President Margaret E. O'Kane Thursday at a news conference in Washington. "As we speak, decisions about our healthcare system are being made on Capitol Hill that will affect our country's future. We can't afford to get this wrong: The money and the human costs are too high."

The problem this year, though, is that for the most part, "the quality results are not at the same level of improvement that we've seen in the past," she said. In other words, they have been flat, stagnant—or just plain stuck in neutral compared with previous years.

The trend was seen in care provided to people with private insurance coverage, as well as Medicare and Medicaid coverage. For commercial plans, 57% of measures showed no statistically significant improvement; for Medicaid Plans, 64% of measures showed no statistically significant improvement; and for Medicare Plans, 86% of measures showed no statistically significant improvement.

"There are some bright spots, but overall, we feel frustrated that we don't seem to put our power behind what we really want. So if we really want quality, we need to send a signal to all phases of the healthcare system that we're really serious . . . that we have to be very clear about what we want and then put our money where our mouth is."

To turn this trend around, lawmakers on Capitol Hill should consider several areas of reform, O'Kane suggested:

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

"Everybody in American deserves to have the best healthcare," she said. Improving healthcare quality can have significant benefits beyond the healthcare system itself. NCQA estimates that were all health plans able to perform at the level of the top 10% of plans, the U.S. would avoid between 49,400 and 115,300 deaths annually and save at least $12 billion in medical costs and lost productivity every year.

This year, NCQA's State of Health Care Quality Report examined quality data submitted by an all time high 979 health plans across the country that collectively cover 116 million Americans—a 9% increase over 2008. Plans submit data using NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS), a set of measures that assess how often patients receive care that conforms to evidence based guidelines.

And while the data show that the system has hit a "performance plateau," some bright spots did emerge, such as a 12% jump in the provision of beta blocker drugs to Medicare patients who had a heart attack within the previous six months, and substantial gains in helping Medicaid beneficiaries stop smoking.

Quality of care, though, tended to vary sharply depending on where people live. NCQA’s analysis of care for several chronic illnesses found that people in some parts of the U.S. were far less likely to receive appropriate care than were people in other parts of the country.

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