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Managed Care Quality Improved in 1999, NCQA Data Show

Nancy Tarleton Landis

The quality of health plans' performance improved more in 1999 than in any year since annual reporting on the state of managed care by the National Committee for Quality Assurance (NCQA) began. Across all measures of clinical quality and all regions of the United States, plans reporting to NCQA had their largest gains ever. Many health plans that have performed poorly in the past accounted for some of the most impressive gains, NCQA said.

Cardiac care is one area of improvement highlighted in this fourth annual NCQA report (PDF) on plan performance. The rate of prescribing of beta-blockers after heart attack rose from 80% in 1998 to 85% in 1999. In 1996 the rate was only 62%—still "far higher than any documented performance in the nonmanaged care environment." The change since 1996, says NCQA, means that in the average plan, with 190,000 members, 18 fewer people each year will suffer a second heart attack and 6 fewer people will die from heart attack. One of the most promising findings in 1999, NCQA said, was in the rate of screening for serum cholesterol after hospitalization for acute myocardial infarction, coronary artery bypass grafting, or percutaneous transluminal coronary angioplasty: 69%, compared with 59% in 1998.

The recent report is based on information from 466 HMO and point-of-service plans covering some 51 million people. Most of the data come from NCQA's accreditation and Health Plan Employer Data and Information Set (HEDIS) programs. NCQA says about half of the nation's HMOs participate in the accreditation program and 90% submit HEDIS performance data.

As in previous years, performance varied considerably by plan and region. The plans that perform best and show substantial, sustained improvement, says the report, are those that are accredited by NCQA and make their performance data available to the public—a finding that "should provide impetus for louder calls for similar accountability from other parts of the health care system." NCQA recently began accrediting preferred-provider organizations and will report PPO performance data in the future.

The 2000 report focuses on 18 clinical HEDIS measures, including 6 that were used for the first time in 1999. Among the new measures are use of asthma medication and control of blood pressure, serum cholesterol, and diabetes mellitus. The 1999 baseline data on asthma medication show that, across plan members of all ages, 57% were prescribed medications deemed acceptable by the National Heart, Lung, and Blood Institute as primary therapy for long-term control of asthma. Blood pressure was adequately controlled (140/90 mm Hg or lower) in only 39% of adults with diagnosed hypertension.

A new feature of the 2000 report is short summaries detailing the efforts of individual plans that realized significant improvement in select measures. For example, CIGNA Healthcare, South Carolina, increased prescribing of beta-blockers after heart attack by identifying patients while they were still in the hospital and actively communicating with physicians about preventing future complications.