Report links health plan quality and satisfaction
There is a strong link between health plan quality and consumer satisfaction, according to the National Committee for Quality Assurance’s (NCQA) third annual State of Managed Care Quality report.
Based on information generated by the Con-sumer Assessment of Health Plans Study (CAHPS 2.0H), a new survey tool included in the 1999 Health Plan Employer Data and Information Set (HEDIS), NCQA reports that members of plans that scored in the top 25% on HEDIS Effectiveness of Care measures rated their plans higher across every measure of satisfaction, access, customer service, and overall performance.
For example, 62.6% of members in health plans with strong clinical performance gave their plan high marks overall, while only 55.3% of those in plans with weaker clinical performance felt as positive about their plan. Members of plans with strong clinical performance also reported being more satisfied with customer service (59.2% satisfied vs. 52.1%), claims processing (83% satisfied vs. 75.2%), and getting needed care (78.3% satisfied vs. 71.9%), as compared to those in plans with weaker HEDIS results.
Accredited and nonaccredited performance
The report from the Washington, DC-based managed care watchdog group also notes dramatic differences in performance between NCQA-accredited and non-accredited plans, where the performance gap widened over a year ago and now covers nearly every single measure of clinical performance.
For example, cervical cancer screening rates are 5% higher in accredited plans, eye exam rates for diabetics are 8% higher, and adolescent immunization rates are 16% higher. Members of accredited plans also report higher overall ratings of their health plans, and greater satisfaction with customer service.
"Given the mountain of evidence we now have, it’s difficult to understand why anyone would want to do business with a health plan that doesn’t participate in accountability efforts," said NCQA president Margaret E. O’Kane in a statement. "They just don’t measure up and, worse, they don’t appear to be trying."
Among the main findings of the report is that health plans that consistently measure and report on their performance improve over time. For example, health plans that have a two- or three-year history of publicly reporting adolescent immunization rates outperformed those new to the reporting process by 25% (67.9% vs. 42.9%).
Similar differences were noted on performance measures such as beta blocker treatment after a heart attack (85% vs. 72.8%). Overall, the differences in performance between long-term public reporters and health plans new to the reporting process ranged from about 6% to more than 25%.
Repeat public reporters also outperformed first-time reporters on new HEDIS measures such as cholesterol screening (63.6% vs. 55.3%) and chicken pox vaccination (52.6% vs. 49.8%), the report states. This finding, according to a statement from NCQA, "indicates that embracing performance measurement has a positive impact which extends beyond those aspects of care currently being measured."
The State of Managed Care Quality report is based on analysis of health plan performance data from NCQA’s Quality Compass 99, a massive database of performance information from 247 organizations representing 410 health plans with nearly 70 million enrollees. The full text of the report is available on NCQA’s Web site (http://www.ncqa.org). Quality Compass 1999 is available on CD-ROM or as several Microsoft Excel files of SAS data sets. For more information, contact the NCQA Publications Center at (800) 839-6487.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content