NATIONAL REPORTS—As if it weren't bad enough news that healthcare costs continue to spiral upward, the benchmark quality report for 2009 from
the National Committee for Quality Assurance (NCQA) reveals that quality has stalled somewhat. In fact, the report examined
the link between the cost and quality of care and found little or no connection between the two.
"The State of Health Care Quality: 2009" report examined quality data submitted by 979 health plans across the country that
collectively cover 116 million Americans, a 9% increase over 2008's sample.
Percentage of HEDIS measures showing statistically significant improvement (2009)
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"Hundreds of health plans have made the commitment to measure and report on the quality of care provided to their members.
Those plans have made remarkable progress in improving care," said Margaret E. O'Kane, president of NCQA. "But they can't
do this alone. It's time for all plans and providers to step up to the plate and do the right thing for their members."
The stagnation of quality came as a disappointing surprise after a decade of improvements and was seen in all areas of healthcare—private
coverage, Medicaid and Medicare. "The status quo is unacceptable," O'Kane said during a press conference last month. "Overall, the [quality] gains are pretty
small, particularly among the most vulnerable populations," as plans serving Medicare and Medicaid patients failed to show
noticeable improvement in many key quality measures for the third consecutive year.
Among the notable areas in which quality has stalled:
- Only 46.4% of people taking anti-depressant drugs are monitored by their physicians;
- 34.1% of children prescribed medications for attention deficit hyperactivity disorder are seeing a doctor for follow-up care;
- Half of patients previously hospitalized for mental illness see a physician for a follow-up visit;
- 45.3% of people are receiving colon cancer screening at the appropriate age; and
- Only 42.6% of patients with alcohol or drug dependency are get treatment for the condition.
Despite those disappointing results, there were several bright spots. Among them were a 12% increase in the provision of beta-blocker
drugs to Medicare patients who had a heart attack within the previous six months; nearly across-the-board high-quality care
for asthma patients; and substantial gains in smoking-cessation efforts in the Medicaid population.
"Sometimes, a plateau is just a place to get your bearings and figure out what your next strategy is going to be, and that's
the kind of plateau I think this is," O'Kane says.
The need to get healthcare quality back on the path to improvement is dramatic, however. NCQA says that if all health plans
were able to perform as well as the top 10% of plans did, the United States would realize fewer deaths and save at least $12
billion in medical costs and lost productivity every year. If every American were able to receive care that matched the quality
of that provided by those plans in the top 10%, the number of lives saved would range between 165,000 and 272,000 annually.
Where those saved lives come from might depend on geography; the New England region had the highest-quality health plans,
while the South Central region of the United States came in last.
"Every American deserves to have quality care, and a diabetic in Alabama shouldn't get poorer care than a diabetic who lives
in New Hampshire," O'Kane says.
