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MCOs Need to Watch Their Cholesterol Levels

Cheryl A. Thompson

Cholesterol management of enrollees after a myocardial infarction or other acute cardiovascular event may prove to be a challenging quality measure for managed care organizations (MCOs).

Information released in May by the nonprofit Alliance for Aging Research suggests that, in recent years, only 20 percent of older people with heart disease received a prescription for a lipid-lowering drug. Although this figure does not differentiate self-paying patients from patients with health insurance, the low prescription rate indicates that MCOs should look closely at their own situation. 

In 1999, the National Committee for Quality Assurance (NCQA) started requiring MCOs to report their management of low-density lipoprotein (LDL) cholesterol levels for Medicaid, commercial, and Medicare members who had an acute cardiovascular event in the previous calendar year. The 2000 version of the Health Plan Employer Data and Information Set, NCQA's performance measurement tool, also requires MCOs to substantiate the achievement of LDL cholesterol levels below 130 mg/dL. 

Also reported by the Alliance was the finding that only 45 percent of older people with a high cholesterol level received a prescription and instructions on following a low-cholesterol diet. The research findings derive from a national four-year retrospective study of 75,000 office-based physician visits conducted by the nonprofit Project HOPE. The Alliance requested the study, which was funded with an educational grant from Bayer Corp., maker of Baycol, or cerivastatin.