Managed Care

 

Quality at accredited health plans takes big step forward

MANAGED CARE October 2004. © MediMedia USA
Snapshot

Quality at accredited health plans takes big step forward

MANAGED CARE October 2004. ©MediMedia USA













The quality of care delivered by health plans that report performance data to the National Committee for Quality Assurance improved markedly in 2003, according to the organization's annual industry report, though NCQA officials are quick to add that they're worried about what's going on at those plans that do not participate in accreditation.

"The performance improvements recorded last year among the 563 health plans that reported results were among the largest ever recorded," notes the State of Health Care Quality 2004. "...On several key measures, average health plan performance improved by 4 percentage points or more."

However, the report also examines data collected by some of the health plans that refuse to be indentified to the public. About 75 percent of enrollees belong to plans that do not report quality information publicly. Those plans "nonpublic reporters " lag in nearly every quality category. But, as NCQA spokesman Brian Schilling told us, "At least they're measuring something." PPOs and consumer-directed health plans do not participate in HEDIS performance measurement at all, even anonymously.

As the report states: "At a time when the national trend in health insurance is to move away from the tight networks of health maintenance organizations toward the broader access of preferred provider organizations and the Web-powered promise of 'consumer-directed' health plans (CDHP), there is also a danger that some of the gains of the past decade — a result of a focus on plan-initiated care management and preventive care — will be lost."

Nonpublic reporters don't score as high

The numbers reflect the percentage of people enrolled in those plans that get the right care (e.g., 88 percent of people enrolled in publicly reporting plans who have diabetes will get a lipid profile test at an appropriate interval).

SOURCE: THE STATE OF HEALTH CARE QUALITY 2004, NATIONAL COMMITTEE FOR QUALITY ASSURANCE

Meetings

Private Health Insurance Exchanges Conference Washington, D.C. October 7–8, 2014
National Healthcare Facility Management Summit Palm Beach, FL October 16–17, 2014
National Healthcare CFO Summit Las Vegas, NV October 19–21, 2014
National Healthcare CXO Summit Las Vegas, NV October 19–21, 2014
Innovative Member Engagement Operations For Health Plans Las Vegas, NV October 20–21, 2014
4th Partnering With ACOs Summit Los Angeles, CA October 27–28, 2014
2014 Annual HEDIS® and Star Ratings Symposium Nashville, TN November 3–4, 2014
PCMH & Shared Savings ACO Leadership Summit Nashville, TN November 3–4, 2014
World Orphan Drug Congress Europe 2014 Brussels, Belgium November 12–14, 2014
Medicare Risk Adjustment, Revenue Management, & Star Ratings Fort Lauderdale, FL November 12–14, 2014
Healthcare Chief Medical Officer Forum Alexandria, VA November 13–14, 2014
Home Care Leadership Summit Atlanta, GA November 17–18, 2014