Business pundits often say What gets measured gets improved.

But it takes time, according to the latest State of Health Care Quality Report from the National Committee for Quality Assurance.

NCQA tracks HEDIS measures for more than 1,000 health plans. The HEDIS tool measures care such as asthma medication use, weight management, and controlling blood pressure. Comparing 2009 to 2010, many measures showed little meaningful change, except for colorectal cancer screening, use of spirometry testing for COPD and pharmacotherapy management of COPD (all improved).

But over time, 23 of the 32 HEDIS Effectiveness of Care measures showed clear trends of improvement among commercial HMOs. Over the past six years, measures showing the most improvement were colorectal cancer screening, HbA1c screening for diabetics, and medical attention for nephropathy. The latter two likely reflect the fact that most health plans have disease management programs for members with diabetes a move considered low-hanging fruit for improving care and cutting medical costs.

NCQA also looks at the overuse of certain procedures and drugs, and found no improvement over six years in the overuse of imaging studies for low back pain, and an increase in the overuse of antibiotic treatment in adults with acute bronchitis.  Besides disease-specific data, the report compares HMOs to PPOs. HMOs rated 6 percent higher than PPOs on patient experience (likely a result of higher cost-sharing for PPOs), but PPOs outperformed HMOs on measures related to drug therapy and monitoring.

The NCQA report should be required reading for pharmaceutical marketers, who can mine its content for partnership opportunities with health plans, employers, and providers. The Accountable Care Act provides numerous incentives for improving the quality and efficiency of healthcare. Payers and providers have a bigger stake than ever in making that happen.

 

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