Report: Health Care Quality Improves But Varies Across Different Regions Of The USA

Main Category: Public Health
Also Included In: Health Insurance / Medical Insurance
Article Date: 02 Oct 2008 - 9:00 PDT

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The quality of health care for millions of Americans improved in 2007 but significant variations in performance continue to leave many people receiving substandard care, according to a report released today by the National Committee for Quality Assurance (NCQA). And while quality improved for most people in private health insurance plans, there was little improvement in the care delivered to those enrolled in Medicare and Medicaid, the nation's two largest public health care programs. Eliminating variations in the delivery of evidence-based care across the health care system could save up to 88,000 lives each year, the report concludes.

Each year, NCQA examines the state of health care quality through data submitted by health plans across the country. In 2008, a record 845 health plans reported on their performance covering 106 million Americans-a 29 percent increase over 2007. These data paint a picture of the American health care system that highlights where it is performing well and where it needs improvement. The report is issued as the U.S. is poised to debate comprehensive health care reform as promised by the two major party candidates for President.

"True health care reform must address the gaps and inconsistencies in quality that deny millions of people the care they deserve," said NCQA President Margaret E. O'Kane. "A comprehensive assessment of quality is the first step in strategically addressing reform."

NCQA uses data from the Healthcare Effectiveness Data and Information Set, or HEDIS®, a set of measures that assess how often patients receive care that conforms to evidence-based guidelines. HEDIS measures assess a spectrum of care ranging from prevention to chronic disease management including immunizations, cancer screenings, advice to quit smoking, blood pressure control and medication management.

Commercial health plans showed improvements on 44 of 54 measures of health care quality, with 16 significant gains in such areas as blood pressure control and postpartum care for women and their newborns. In contrast, health plans serving Medicare beneficiaries posted gains on only 24 of 45 measures of care, and many of those improvements were quite small. One area of notable improvement was the rate at which Medicare beneficiaries were kept on life-saving beta-blocker drugs six months after suffering a heart attack.

There was little improvement in the quality of care provided to Medicaid beneficiaries. Among the 52 measures collected from Medicaid plans, only 26 showed any increase and most of those were very small. One exception: delivery of childhood immunizations.

Overuse of antibiotics continue to be a cause for concern

One unsettling trend detailed in the report is the overuse of antibiotics for adults with acute viral bronchitis. In 2005, NCQA began measuring the overuse of these drugs in adults and children. In that first year, nearly two thirds of adults with acute viral bronchitis were found to have been prescribed an antibiotic despite the fact that such drugs have no effect on that condition. In 2007, that number rose to 75 percent. Such inappropriate care wastes vital health care resources and contributes to the rise of drug-resistant bacteria, threatening the health of patients and communities. Interestingly, health plans and physicians appear to be doing a better job with children; inappropriate use of antibiotics in that age group was between 15 and 25 percent.

Variations in quality pervade the system

The quality of care for Americans varies sharply depending upon where people live. NCQA's analysis of the performance across all HEDIS effectiveness of care measures shows that commercial health plans in New England - Maine, New Hampshire, Vermont, Massachusetts, Connecticut and Rhode Island - performed at a rate that exceeds the national average by 4.7 percentage points. In sharp contrast, commercial plans in the South Central census region - Texas, Oklahoma, Arkansas, Louisiana, Mississippi, Alabama, Tennessee and Kentucky - reported quality scores that averaged 4.0 points below the national average.

Quality found to vary across types of plan

This year, 240 preferred provider organizations (PPO) reported on the quality of their performance, including 99 plans that reported for the first time. A comparison of the performance of different types of plans showed HMOs averaging three percentage points higher than PPOs on the same measures. PPOs' performance on a few measures, including follow-up after hospitalization for mental illness and persistent beta-blocker treatment after a heart attack, significantly trailed those of HMOs. "Over the last three years, PPOs have come forward in force to measure and report on their quality," added O'Kane. "Thanks to their leadership, we have a clearer picture than ever before on how well we're doing."

Reform recommendations to policymakers

Based on this year's report, NCQA urges policymakers to include three important elements in any health reform bill. They are:

- Require routine quality measurement and reporting by all health plans and providers. Despite recent progress, nearly 200 million Americans know very little about the quality of the care they receive;
- Establish benchmarks for improvement in each region of the country to reduce variations in care quality; and
- Enact reforms that tie payment to the quality of care delivered by plans and providers.

The State of Health Care Quality 2008 is available to the public on NCQA's Web site, http://www.ncqa.org/sohc. Much of the data from the report is used in NCQA's new Health Plan Report Card, which allows consumers to compare health plans based on NCQA Accreditation results and HEDIS quality scores. To see the new Health Plan Report Card, log on to http://reportcard.ncqa.org.

NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations and recognizes physicians in key clinical areas. NCQA's Healthcare Effectiveness Data and Information Set (HEDIS) is the most widely used performance measurement tool in health care, safeguarding the care of more than 100 million Americans. NCQA is committed to providing health care quality information through the Web, media and data licensing agreements in order to help consumers, employers and others make more informed health care choices.

National Committee for Quality Assurance