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HMO care is better, says accrediting group

Despite three straight years of improvements in the quality of health care provided by HMOs, Americans could avoid more than 22 million sick days each year if all HMOs adopted a "best practices" approach to health care, according to the National Committee for Quality Assurance (NCQA).

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Top 15 NCQA-accredited HMOs
(Listed alphabetically)

  • Anthem Blue Cross and Blue Shield, Connecticut
  • Anthem Health Plans of Maine
  • Anthem Health Plans of New Hampshire
  • Capital Group Health Services of Florida
  • Excellus Health Plan
  • Fallon Community Health Plan
  • Group Health Cooperative of South Central Wisconsin
  • Harvard Pilgrim Health Care
  • Harvard Pilgrm Health Care of New England
  • HealthAmerica Pennsylvania
  • Kaiser Permanente, Colorado
  • Physicians Plus Insurance Corp.
  • Security Health Plan of Wisconsin, Inc.
  • Touchpoint Health Plan
  • Tufts Health Plan

Source: National Committee for Quality Assurance

In its annual "State of Health Care Quality" report, the NCQA finds significant improvements in key measures of health care by those plans that report health care data for NCQA evaluation. However, the report also finds that people who suffer from asthma, depression, diabetes, heart disease, and hypertension lose an estimated 22,781,370 days from work due to their medical conditions.

Make no mistake about it, says the NCQA, "opportunities for improvement still abound" because the data that show improvement only covers about one in four insured Americans. "The other three-quarters are likely to receive care and service from providers and organizations that neither measure nor report quality information." NCQA is a private, nonprofit accrediting organization dedicated to improving health care quality.

Make no mistake about it, says the NCQA, "opportunities for improvement still abound" because the data that show improvement only covers about one in four insured Americans. "The other three-quarters are likely to receive care and service from providers and organizations that neither measure nor report quality information." NCQA is a private, nonprofit accrediting organization dedicated to improving health care quality.

According to the report, the percentage of patients who had their blood pressure treated rose to 55.4 percent in 2001 from 51.5 percent in 2000, and from 39 percent in 1999. However, the NCQA also says Americans lose an estimated 1.9 million days from work a year due to hypertension

Touchpoint is No. 1

NCQA lists the top 15 NCQA-accredited HMOs in the country according to how well they perform on the "Health Plan Employer Data and Information Set," or HEDIS measures. HEDIS is a set of standardized performance measures designed to ensure that employers and consumers have the information they need to reliably compare HMO performance. The performance measures in HEDIS are related to many public health issues such as cancer, heart disease, smoking, asthma, and diabetes.

According to NCQA spokesperson Brian Schilling, no other health plan in the nation performed as well on the HEDIS measures as Touchpoint Health Plan, a 160,000-member HMO in northeast Wisconsin. Schilling says Touchpoint was among the first in the nation to earn an "excellent" accreditation from NCQA and is the highest-performing plan in the nation overall in the HEDIS measures. It set the national benchmark in 2001 with the top scores in four measures, including:

  • 90 percent of its patients received breast cancer screening.
  • 100 percent received beta blocker treatment after a heart attack.
  • 94 percent of diabetes patients received eye exams.
  • 75 percent received cholesterol control.

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