Measurement improves health care quality for 70 million Americans

But gaps remain

More than 70 million Americans enrolled in private health plans saw the quality of their health care improve in 2005, according to a report by the National Committee for Quality Assurance. NCQA is a nonprofit organization that, among other things, accredits and certifies a wide range of health care organizations.

NCQA says one in four Americans is enrolled in a health plan that collects and reports data on the quality of care. Among private commercial plans, 2005 marked significant improvements in childhood and adolescent immunizations. People enrolled in Medicare health plans saw important gains in smoking cessation, while those in Medicaid plans benefited from a sharp increase in childhood immunizations.

According to the report, people in health maintenance organizations (HMOs) and point-of-service (POS) plans are much more likely to benefit from quality measurement than those in other plans. More than 73% of such plans submitted performance data in 2005, the highest proportion in history. But enrollment in such plans has declined to 33% today. Most Americans (more than six in 10) are now in preferred provider organizations (PPOs) and consumer-directed health plans (CDHPs). The overwhelming majority of those plans do not yet collect and report data on the quality of their care.

In 2005 NCQA asked PPOs to voluntarily report their performance; a total of 80 commercial PPOs did so in 2005. This has helped to reverse a three-year decline in the number of people in accountable health plans; 12 million more people are now in accountable plans than last year.

But more than 100 million insured people still do not enjoy the improved care that results from quality reporting.

Despite the reported gains, huge differences persist between the performance of the health care system as a whole and the top accountable health plans. NCQA estimates that if the entire system performed at the level of the top plans, between 37,600 and 81,000 lives would be saved each year. These quality gaps also lead to over $10 billion in lost productivity and almost 65 million avoidable sick days.

New strategies needed to maintain improvements

NCQA is pursuing new strategies to achieve continued gains. One key to further improvement is increasing the number of accountable health plans that report quality data. NCQA is working with consumers, employers and health plans to expand the number of accountable PPOs and CDHPs.

That effort will receive a significant boost in 2007: The Centers for Medicare & Medicaid Services (CMS) has required PPOs participating in the Medicare Advantage program to report data measures for public reporting in 2007. In addition, the Office of Personnel Management (OPM) has required PPOs and other fee-for-service plans serving 9 million federal employees to report five data measures in 2007 for public release in 2008.

Last August, President Bush signed an executive order directing federal agencies sponsoring or administering health plans to provide information on cost and quality to beneficiaries.

Note: The “State of Health Care Quality 2006” may be downloaded at no cost from NCQA’s Web site, www.ncqa.org. Additional health care quality information is available on the NCQA Web site to help consumers, employers and others make more-informed health care choices.