Quality at accredited health plans takes big step forward


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).