Most of US Healthcare System Still Lagging on Quality

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Most of US Healthcare System Still Lagging on Quality

By Pallarito

NEW YORK (Reuters Health) Sept 18 - While health plans have made dozens of

specific quality-of-care improvements in the past year, America's healthcare

system remains largely unaccountable, exposing patients to sub-optimal care,

a major health plan accreditation outfit reported on Wednesday.

More than 6,000 deaths and 13 million sick days could have been avoided

annually if all US healthcare providers and organizations adopted the best

practices of the top health plans, it said.

" In general, accountability in healthcare is the exception, " Margaret

O'Kane, president of the National Committee for Quality Assurance, said at a

press conference Wednesday morning.

About one in four insured Americans are enrolled in plans that track and

report on the quality of care delivered, NCQA said. For the third straight

year, those plans are reporting substantial improvements, on average, in the

care provided to patients, it said. Health plans are more consistently using

beta blockers to prevent heart attacks and managing diabetic patients more

aggressively, for example.

But for three-quarters of Americans who receive their care from

organizations that do not publicly report on their performance, the news is

grim. The data suggest that these insured individuals are receiving care at

a level that is " well below " that of health plans that publicly report on

their performance.

" Why is it OK that the rest of healthcare doesn't play by the same rules? I

don't think it is, " O'Kane said.

NCQA's sixth annual report, " State of Health Care Quality, " provides perhaps

the strongest evidence to date that measuring and reporting performance

results in better care. The report is based on data collected for NCQA's

accreditation program and for " Quality Compass, " a comprehensive database of

health plans' performance results.

" NCQA kind of showed America the way in terms of scientifically valid,

comparable performance measures, " said Dr. Arnold Milstein, medical director

of the Pacific Business Group on Health and a principal with Mercer Human

Resources Consulting. " They are a hugely positive force in driving forward

this vision...for more market justice for high-performers in healthcare. "

The report provides specific measures of performance on key measures of care

for nearly 300 health plan products serving 71.3 million Americans. For the

first time, it also includes data on the care of Medicare and Medicaid

health plan enrollees.

Health plans reported remarkable gains in use of beta blockers after a heart

attack, an intervention studies have shown to be highly effective in

preventing future heart attacks. In 2001, 92.5% of candidates for the drugs

received them, a gain of 50% from 1996. Thirteen health plans reported

prescribing beta blockers to 100% of their heart attack patients.

Health plans have already saved an estimated 10,000 lives through beta

blocker treatment, NCQA said. If every health plan adopted the practice, it

estimates that an additional 1,200 lives could be saved every year.

Plans also reported sharp increases in the percentage of patients who have

their high blood pressure under control (from 51.4% in 2000 to 55.4% in

2001) and their cholesterol in check (53.4% to 59.3%).

" What's all the more impressive is that these are not necessarily things

that plans have total control over, " said O'Kane, noting that patients also

need to play an active role in managing their high cholesterol.

Still, performance varies widely among accountable health plans and there

are " several clinical areas where improvement is either extraordinarily slow

or nonexistent, " NCQA observed.

Health plans' average scores in the area of antidepressant medication

management, for example, have decreased since 1999. This area alone

represents a vast opportunity for improvement and significant potential

savings for employers. If healthcare organizations mirrored the depression

management practices of the top health plans, a retail company with a

workforce of 30,000 could slash 3,003 days of depression-related

absenteeism, saving $470,000 in paid sick days, the report said.

" This is not only about economics. This is about how people feel, " O'Kane

pointed out. She said there is a tremendous opportunity to improve people's

quality of life and productivity on the job.

This year's report, for the first time, also shows that measuring

performance at the physician level improves quality-of-care. Physicians

earning recognition under a performance benchmarking program that NCQA

co-sponsors with the American Diabetes Association " far exceed national

averages on every single measure of diabetes care, " the accreditation group

found.

Wisconsin's Touchpoint Health Plan ranked the year's strongest overall

performer on HEDIS, the performance measurement tool that NCQA uses to

accredit health plans. Successful plans, like Touchstone, seem to share a

few common practices, NCQA said. In Touchpoint's case, its strong, collegial

relationship with physicians, use of incentives for rewarding quality,

physician report cards and quality-focused culture made a difference.

Although NCQA will continue to monitor health plan performance, O'Kane said

the only way to drive improvement among the 72% of healthcare organizations

that fail to measure and report performance is to focus at the provider

level. With healthcare costs rising and HMOs " sort of stalled at the

moment, " there is a " greater urgency " to drill down to the provider level,

she said.

The accrediting outfit has pilot projects in Minnesota and California to

test a " pay for performance " system of reimbursement for medical groups, for

example.

It also intends to launch a certification process to recognize physician

offices that have superior systems in place for improving patient care. The

program would be designed to recognize doctors' offices capable of

identifying patients in need of cardiac or diabetes care, for example,

reaching out to those patients and knowing whether patients are having the

required tests and follow-up care, she explained. " Those kinds of underlying

systems are what we're really talking about. "

Large employers also are beginning to focus on driving better provider

performance through their purchasing decisions. Francois de Brantes, program

leader for healthcare initiatives at General Electric, noted that GE is part

of a broader coalition of employers in a " pay for quality " initiative that

will provide bonus payments to physicians that improve the care they provide

to diabetic patients. The effort builds on NCQA's own diabetes provider

recognition program.

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