NCQA report: MCOs improve little in 1998

Pharmaceutical Representative

Managed care plans showed little overall improvement in providing quality care from 1996 to 1997, according to a new report from the National Committee for Quality Assurance.

Managed care plans showed little overall improvement in providing quality care from 1996 to 1997, according to a new report from the National Committee for Quality Assurance.

In its second annual edition of "The State of Managed Care Quality" report, the NCQA stated that it saw only 1% improvement on some quality measures, and noted no major gains for the industry overall.

One exception to this finding, however, was in anti-smoking efforts. The NCQA wrote: "Just one year after NCQA introduced a new Health Plan Employer Data and Information Set measure related to physician advice to stop smoking, providers are delivering such advice substantially more often (64% vs. 61%). This will save hundreds of lives and millions of dollars over the next decade."

The NCQA evaluated HEDIS data from 447 health care plans and managed care organizations. In total, the data on plan-specific performance, accreditation and member satisfaction information represents coverage of 60 million American lives.

Despite the lack of significant gains in clinical and satisfaction measures industrywide, NCQA found that health plans that submitted data for both 1996 and 1997 outperformed those plans that were participating for the first time in 1997. This suggests that consistent participation in quality-measurement programs improves health plans over time.

For instance, the overall industry showed an average rate for cervical cancer screening of 71.3% in 1997. Plans that reported in both 1996 and 1997, however, registered an average of 71.5% screenings in 1996 but 73.7% screenings in 1997.

The NCQA also reported that health plans that publicly report performance information perform "substantially better than those that don't on clinical measures, and attain significantly greater member satisfaction." In health plans that allow public reporting of their data, for example, 58.5% of members said they were "completely" or "very" satisfied with care and service. Among those health plans that did not report their data publicly, only 50.4% said the same. Also, children were more likely to have received their full complement of immunizations by the age of two in publicly accountable plans than those in plans that are not (69.3% vs. 57.7%).

Regionally, the NCQA found that plans in New England outperformed plans from other regions. This difference in quality is "undoubtedly related to collaborative efforts between health plans spanning many years, and should serve as a model for plans in other regions," the NCQA opined. PR