NCQA highlights benefits of quality measurement
But quality gaps remain in some areas
After 10 years of collecting, analyzing, and reporting quality data, the National Committee for Quality Assurance (NCQA) asserts in its latest report, The State of Health Care Quality 2006, that the results demonstrate "the long-term transformative effects of quality measures over the duration [of the reports]."
Here are just a few of the highlights from the report:
- Children in commercial health plans are nearly three times more likely to receive all recommended immunizations than they were eight years ago.
- Diabetics are more than twice as likely to have their cholesterol controlled to recommended levels as in 1998.
- More than 96% of patients who suffered a heart attack were prescribed beta-blockers to help prevent a second, often fatal heart attack, up from 62% in 1996 — saving between 4,200 and 5,300 lives over the past decade.
"We are certainly preaching to the choir in saying that measurement drives improvement, but nevertheless what we have found is that measurement serves as a powerful vehicle for improving, and public reporting provides incentives to improve," says Jeff Van Ness, an NCQA spokesman. "We find that public reporting organizations and accredited organizations perform at a consistently higher level than others." While his group exclusively measures health plans, Van Ness adds, "It's almost axiomatic this holds true in the hospital world."
New strategies needed
Despite the reported gains, says the NCQA, enormous differences persist between the performance of the health care system as a whole and the top accountable health plans. NCQA estimates that if the entire health care system performed at the level of the top plans, between 37,600 and 81,000 lives would be saved each year and between $2.6 billion and $3.6 billion in unnecessary hospitalization expenses would be saved. These quality gaps also lead to more than $10 billion in lost productivity and almost 65 million avoidable sick days.
How did NCQA arrive at those figures? "It was done through an exhaustive review of the literature," says Van Ness.
After seven consecutive years of quality improvements there are signs that the pace of improvement may be slowing: fewer measures showed statistically significant year-over-year gains than in 2004. This may indicate that in some cases, there is less room for improvement. NCQA is pursuing new strategies to achieve continued gains.
"There are a few moving parts," notes Van Ness. "One is that while we certainly have an excellent set of measures for a limited number of conditions, there are still gaps in this measurement set, if only because there are corresponding gaps in the evidence base."
Effective quality measurement
In some cases, he says, the issue is effective quality measurement. "Is there a way quality can be effectively measured using objective criteria in a way that does not involve an undue measurement burden?" he poses. "In addition, sometimes there is not as much absolute clarity in the evidence base around some conditions as there is for others. While everyone can agree that, in nine of 10 cases, beta-blockers are appropriate after someone suffers an MI, for other conditions it's not quite a 'lay-up.' This points to the need for more research, and consensus for a proper way to move forward."
In addition, to help facilitate better comparisons among health plans, NCQA is developing a common set of quality standards to apply to all health plans. This initiative, which will be implemented in 2008, is designed to evaluate all health plans on a single set of standards and to allow consumers to compare plans based on a common set of criteria.
One key to further improvement, Van Ness continues, is increasing the number of accountable health plans that report quality data. NCQA is working with consumers, employers, and health plans to expand the number of accountable PPOs (Preferred Provider Organizations) and CDHPs (Consumer-Driven Health Plans).
That effort will receive a significant boost in 2007: The Centers for Medicare & Medicaid Services (CMS) has required PPOs participating in the Medicare Advantage program to report HEDIS measures for public reporting in 2007. In addition, the Office of Personnel Management has required PPOs and other fee-for-service plans serving 9 million federal employees to report five HEDIS measures in 2007 for public release in 2008.
New measures
To help determine the efficiency of health care providers, says the report, NCQA has developed a first-generation of Relative Resource Use of HEDIS measures.
These measures, when combined with HEDIS measures, will provide for standardized, risk-adjusted comparisons of provider networks based on efficiency — i.e., how much health care purchasers get for their health care dollar.
These measures cover six conditions: diabetes, cardiac conditions, asthma, chronic obstructive pulmonary disorder (COPD), uncomplicated hypertension, and acute low back pain. According to NCQA, these conditions collectively account for 50% to 60% of all direct medical expenses.
"Finally, we will not only broaden the scope of what we look at, but we will get a more granular picture — with more widespread measures," says Van Ness. "This will give us a much more complete picture of what's going on."
For more information, contact:
Jeff Van Ness, National Committee for Quality Assurance, 2000 L Street, NW, Suite 500, Washington, D.C. 20036. Phone: (202)-955-3518. The report may be downloaded at no cost from NCQA's Web site, www.ncqa.org.
The National Committee for Quality Assurance (NCQA) asserts in its latest report, The State of Health Care Quality 2006, that the results demonstrate "the long-term transformative effects of quality measures over the duration [of the reports]."You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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