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Study shows HMO quality improving

A survey shows for the third year in a row, health care quality for millions of Americans improved substantially, despite broad public concerns over cost, the uninsured, patient safety and other system-wide problems.

The State of Health Care Quality report from the National Committee for Quality Assurance (NCQA) documented significant improvements in more than a dozen key areas among selected health plans. The report also found despite these improvements, more than 6,000 deaths and 22 million sick days could be avoided annually if the "best practice" care found at the nation’s top organizations were adopted universally.

"This year, 13 health plans delivered beta blockers to 100 percent of patients who had a heart attack. That’s the payoff for measuring quality," said NCQA President Margaret O’Kane. "But we have work to do—a large part of the health care system still doesn’t measure anything."

The NCQA noted several improvements. For example, between 2000 and 2001, the percent of patients who had their high blood pressure under control rose from 51.5 percent to 55.4 percent. In 1999, this rate was 39 percent. Fifty million Americans have high blood pressure, which, left uncontrolled, can cause stroke, coronary heart disease, kidney failure and blindness.

NCQA also found improvements in treatment of high cholesterol. Among commercial managed care organizations, 59.3 percent of heart attack patients had their cholesterol under control in 2001, nearly a 6 percent increase from the previous year, and up 14 percent from 1999. High cholesterol can cause coronary artery disease, a condition afflicting 15 million Americans.

Medicaid & Medicare

For the first time, NCQA’s report includes performance results from Medicaid and Medicare. NCQA found Medicaid and Medicare recipients often receive the same level of health care, as those covered by private health plans. For example, 89.4 percent of heart attack patients in commercial organizations received beta blockers, versus 89.3 percent in Medicare plans and 82.9 percent in the Medicaid program. Beta blockers are extremely effective in reducing the chances of a second heart attack, and increase long-term survival rates by as much as 40 percent.

The NCQA study found Medicaid and Medicare organizations actually outperformed commercial plans in several measures.

Accreditation

As has been the case in the commercial sector, there was a considerable difference in performance between Medicare organizations accredited by NCQA and those that were not. In one example, 57.8 percent of heart attack patients enrolled in accredited Medicare organizations in 2000 had properly controlled cholesterol levels, as opposed to 44.1 percent in non-accredited plans.

"The gaps between accredited and non-accredited plans are compelling—they suggest that Medicare beneficiaries would benefit tremendously from a plan that is accredited and accountable," says John Rother, director of legislation and public policy at the American Association for Retired Persons (AARP).

The best of the best

NCQA gave its highest marks to Wisconsin’s Touchpoint Health Plan. NCQA claims a number of factors contributed to Touchpoint’s performance, including its strong, collegial relationship with participating physicians, an incentive structure that rewards quality, quarterly physician-level report cards and a quality-focused culture.

NCQA points out such programs are the key to quality care provided by many of the plans receiving high marks in the study.

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