NCQA reports HMO quality improvement

November 1, 2000

Pharmaceutical Representative

According to the Washington-based National Committee for Quality Assurance's fourth annual State of Managed Care Quality report – an assessment of the industry's performance and the impact improvements will have on Americans' health – health maintenance organizations made their largest gains ever in 1999 in every region of the country and across every single clinical quality measure NCQA examines. The report, which is based on an analysis of health plan performance data from Quality Compass 2000, NCQA's database of managed care information, looks at data submitted by 466 health plans that cover some 51 million people. It also examines Americans' perceptions of managed care.

According to the Washington-based National Committee for Quality Assurance's fourth annual State of Managed Care Quality report – an assessment of the industry's performance and the impact improvements will have on Americans' health – health maintenance organizations made their largest gains ever in 1999 in every region of the country and across every single clinical quality measure NCQA examines. The report, which is based on an analysis of health plan performance data from Quality Compass 2000, NCQA's database of managed care information, looks at data submitted by 466 health plans that cover some 51 million people. It also examines Americans' perceptions of managed care.

Overall improvement

Reporting plans made significant improvements in 1999, showing gains on all clinical quality measures NCQA tracked. Even more encouraging is the finding that many health plans that have performed poorly in the past accounted for some of the most impressive gains.

The report noted the improvement in childhood and adolescent immunizations. In 1997, when NCQA introduced this measure, only 41% of two-year-olds received the recommended chicken pox vaccine. By 1999, the rate had increased to more than 65%. Health plans in general are also getting better at delivering the important MMR (measles, mumps, rubella) booster to adolescents. The average rate for this measure rose from 52% in 1998 to 59% in 1999.

"Preventing an illness is a far bigger victory than curing one," said Walt Orenstein, assistant surgeon general and director of the National Immunization Program at the Centers for Disease Control and Prevention in Atlanta. "So when we see immunization rates going up, I view that as an enormous victory, because what it really means is that disease rates are going down."

Improvements were also shown in cardiac care. Since 1996, when NCQA started measuring the prescription of beta-blockers following heart attacks, the rate has risen from an average of just 62% to 85% in 1999. According to NCQA, this improvement means that each year, in the average reporting health plan, roughly 18 fewer people will suffer a second heart attack, and six fewer will die from a heart attack. Plans have shown similar improvement in screenings for cholesterol after a heart attack, which jumped from a rate of 59% in 1998 to 69% the following year.

Member satisfaction

Another key finding of the report is that the healthcare organizations that keep people healthy also keep them happy. Specifically, health plans that scored in the top 25% of all organizations on the range of clinical Health Plan Employer Data and Information Set measures also did a demonstrably better job of meeting their members' service expectations. Members of those plans were more likely to rate their health plan eight, nine or 10 out of 10 (63%) than members of the poor clinical performers (53%). They were also far more likely to give their plans high marks in such areas as "getting needed care," "customer service" and "claims processing."

"We're proud of this year's results, but the best news is probably yet to come," said Douglas Hadley, regional medical director of Philadelphia-based Cigna Corp. "All of our efforts to improve quality have a cumulative effect that only grows over time - we're already looking forward to next year's HEDIS numbers." PR