Health plans that disclose also perform better
NCQA report shows big gap between plans
Health plans continue to show wide variability on key measures of clinical care, customer service and member satisfaction, according to the National Committee for Quality Assurance’s (NCQA) recently released State of Managed Care Quality report. The second annual report on health plan performance from the Washington, DC-based watchdog organization found that the gap between top- and bottom-performing plans remains enormous. For example, beta-blocker treatment rates range from 52% to 92%.
The report includes data on 292 health plans from Quality Compass 1998, the national health plan database with plan-specific NCQA accreditation status information and 1997 Health Plan Employer Data and Information Set (HEDIS) data. Measures include follow-up after hospitalization for mental illness, childhood immunization status, cervical cancer screening, prenatal care in the first trimester, breast cancer screening, eye exams for diabetics, availability of primary care providers, and member satisfaction. (See examples of care measures, p. 161.)
NCQA-accredited health plans outperformed unaccredited plans by 5% to 10% on several measures such as child and adolescent immunizations and beta-blocker treatment. "This report makes it clear that health plans that invest in quality, and that make a commitment to accountability, deliver higher quality care to their members," says NCQA president Margaret E. O’Kane. The report includes national and regional averages and benchmarks to help em ployers and health plans set performance goals, monitor improvement, and establish overall accountability. NCQA will generate these figures annually to help track the performance of the industry and identify key trends
Fewer health plans were willing to release their performance data publicly this year des pite the general trend toward greater accountability in managed care. In addition to the 292 plans included in the report, another 155 plans provided data to NCQA so it could calculate accurate national and regional performance averages, but they asked that those data not be reported publicly. Some 240 plans publicly reported member satisfaction information. Although a large number of plans provided no data at all, 121 allowed their data to be released for the first time.
"It is important to remember that the lower performers in Quality Compass are not actually the worst plans. Far from it, in fact," says Cary Sennett, MD, PhD, NCQA executive vice president. "There are many plans whose performance is much lower still. The plans that publicly reported their data deserve credit for stepping forward. These are the plans that consumers can expect will get better over time and work to deliver top-quality care."
Overall performance remains unchanged
The report includes national and regional averages for key performance measures and identifies benchmarks showing what level of performance is actually possible. The report also discusses important trends in managed care, the impact on the nation’s health if all health plans were to perform at the benchmark level, and other key findings. Significant findings for 1998 included these:
o The industry’s overall performance was essentially unchanged from 1996 to 1997.
While small improvements in the range of 1% were noted on several measures, notable improvements were recorded on only one measure: how frequently physicians gave advice to quit smoking (64% vs. 61%).
o Plans that reported performance data two years in a row improved more quickly and outperformed the industry as a whole.
For example, adolescent immunization status for plans that reported data in 1997 and 1998 increased from 53.6% to 57.8%; cervical cancer screening rates improved from 71.5% to 73.7%; and the eye exam for diabetics rate improved from 40.2% to 42.4%.
o NCQA-accredited plans outperformed unaccredited plans.
Health plans with full NCQA accreditation outperformed unaccredited plans by a wide margin on most key performance measures. Fully accredited plans also readily exceeded the national averages on every measure.
o Publicly-reporting health plans outperformed plans that were unwilling to make their results public.
Across every measure of performance — including member satisfaction, immunization rates, cancer screening, prenatal care, beta-blocker treatment, eye exams for diabetics, and follow-up for mental illness — health plans that released their performance data publicly outperformed other plans, in some cases by more than 10% (for immunization rates and beta blocker treatment).
o On average, plans in the New England region continued to outperform other plans in the country.
New England plans ranked first in all nine measures of member satisfaction, and first on all nine measures of effectiveness of care. New England plans as a group typically performed more than 10 and as many as 40 percentage points higher than plans from the lowest performing region on each measure.
[The State of Managed Care Quality report is available on the NCQA World Wide Web site at this address: www.ncqa.org. Quality Compass 1998 is available on CD-ROM or as several Microsoft Excel files or SAS data sets, all of which allow for customized sorting and printing of the data. Call the NCQA Publications Center at (800) 839-6487.]
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