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NCQA: Health Plan Quality of Care is Improving

 |  By cclark@healthleadersmedia.com  
   October 31, 2012

In almost all areas measured, the quality of care provided by commercial and Medicare health plans is showing dramatic improvement, a trend that years from now will translate to better health for some 125 million Americans enrolled, according to the 2012 edition of the National Committee for Quality Assurance's annual report, "The State of Health Care Quality."

"One of our core beliefs, borne out of experience, is that what gets measured gets improved," said NCQA president Margaret O'Kane during a briefing Tuesday on the 230-page document.  

The report tracks performance on more than 40 measures surveyed for the Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS) between 2009 and 2011.

Those measures include care for blood pressure and colorectal cancer screening, smoking cessation counseling, use of beta blockers after a heart attack, the use of two or more high-risk medications among seniors, and childhood immunizations.

"In particular, we see some very impressive results...in one of the greatest health threats in the country, obesity," O'Kane said.

One obesity measure, which NCQA introduced in 2009 to the HEDIS survey, scores the percentage of a physician's adult patients who during their office visit got a body mass index assessment.

"This is important because solving the obesity crisis starts with clinicians paying attention to it. If a doctor doesn't care about your BMI, why should you? That's what people might think if their doctor doesn't say anything to them; they assume they're okay," O'Kane said.

Happily, she added, "There's been tremendous improvement...which means that we're bringing this issue into focus in doctor's offices."  Years from now, some overweight or obese people will have lost pounds and avoided disease because their doctor paid attention during the office visit, she said.

Between 2009 and 2011, adults who had an outpatient visit and whose doctor documented their BMI increased from 41.3% to 55.4% for commercial HMOs, from 15.7% to 26.3% for commercial PPOs, and from 38.8% to 68.2% for Medicare HMOs and from 24.1% to 62.2% for Medicare PPOs.

For children, there was even greater improvement in standard of care assessments of weight as well as whether doctors counseled them on exercise and nutrition, other measures in the set. O'Kane said that doctors are realizing they need to stress to their pediatric patients and their parents about the importance of managing diet and nutrition.

In 2009, the percentage of commercial HMO, commercial PPO, Medicaid HMO patients who received physical activity counseling was 36.5%, 17.6%, and 32.5%. But by 2011, the percentages were 43%, 25.7%, and 40.6%

Appropriate colon cancer screening for people between 50 and 75 increased from 60.7% to 62.4% and from 47% to 54.6% for commercial HMO and PPO enrollees, respectively. Among Medicare enrollees, colon cancer screenings increased from 54.9% to 60% and 40.1% to 55.2% for commercial HMO and PPO plan members respectively.

Use of spirometry, appropriate asthma care, appropriate treatment for adults with chronic obstructive pulmonary disease, all showed a 1% to 2% improvement. Blood pressure checks for people diagnosed with hypertension increased 5 percentage points in almost all categories, and for patients in commercial PPO plans, from 48.3% to 58.4%.

The NCQA measures found flat and slight downward changes in the percent of women 40-69 with at least one breast cancer screening within the last two years and flat or slight downward changes in Pap test cervical cancer screening in the last three years for women 21-64.

O'Kane highlighted a particularly "worrisome issue" in immunizations against measles, mumps and rubella, influenza, tetanus, polio and other recommended shots for children, which have been declining since 2009 "because of the urban legend that's out there about autism and immunizations."

"What we had hoped to see was a rebound, but that's not what we're seeing," she said. "Immunization rates have really flattened out."

The NCQA's chart showing all childhood immunizations for HMO commercial plans and Medicaid plans shows a rapid increase from about 50% between 1999 and 2001 to between 75% and 81% in 2008. But in 2009, those rates began to dip back several points, and didn't recover through 2011.

"Now, you're starting to have outbreaks of preventable childhood diseases..." O'Kane says. "It's very distressing. We just hope there can be more effective interventions."

O'Kane emphasized that the 2012 report reflects quality-of-care experiences for enrollees of 728 HMO and POS plans and 329 PPO plans, or 125 million people, 7 million more than in 2011.

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