There was a lot of positive news around health plan quality improvements from a webinar recently sponsored by the National Committee on Quality Assurance. Obesity screenings for adults and children are increasing, and largely because of the Star rating program in Medicare, the quality of care delivered to seniors through Medicare Advantage plans is also dramatically going up.
However, one panelist speaking during the Oct. 30 event said measuring health plan quality is not the most important way to improve population health. ?We need to be measuring what's happening at the accountable provider level (the physician), not the entire accountable care level or the health plan,? said Tom Miller, resident fellow of the American Enterprise Institute and author of ?Why ObamaCare is Wrong for America.?
Miller outlined several cures for America's ailing healthcare system. Among them: truly giving consumers a way to evaluate medical costs ? in other words ?stop hiding the price tag.? He also said care management is much more than a manufacturing process, yet the guidelines for treating specific diseases sound like they?re ?so easy even a caveman could do it.?
Margaret O?Kane, NCQA president, agreed with Miller on several points. She said the NCQA has moved beyond measuring quality at health plans and has programs for patient-centered medical homes and accountable care organizations. She also said the NCQA is currently working with a number of specialist societies to extend some of the principles of the PCMH to more complex care.
O?Kane cited statistics, based on 2011 reporting, about how NCQA-sponsored quality programs are improving population health. Among them:
- The percentage of adults who had their body mass index documented during a year increased from 41.3 percent in 2009 to 55.4 percent in 2011 for HMO members and 34.6 percent to 52.6 percent for adults enrolled in Medicaid programs. The Medicare stats were even more dramatic, going up from 38.8 percent to 68.2 percent for those in Medicare HMOs.
- BMI testing for children also improved, although not quite so much. During the same period, the rates for children 3 to 17 increased from 35.4 percent to 44.7 percent for those in commercial HMOs, from 17.4 to 24.6 percent for those in commercial PPOs and 30.3 to 46.0 percent for enrollees in Medicaid HMOs.
- For controlling LDL cholesterol , the gains were smaller among those in HMOs and more dramatic for PPOs and Medicaid and Medicare plans. HMO rates were up from 47 to 48.1 percent, and Medicare PPO rates increased by more than 10 percentage points.
- Some 125 million Americans are now enrolled in health plans that report quality results, compared with 118 million in 2010.
There are dozens more statistics contained in the NCQA's new 230-page State of Health Care Quality report, but Miller points out that aside from measuring the wrong part of the healthcare system, the indicators may also be biased because plans that are already doing the best job excel at reporting. ?Some plans perform better BECAUSE they supply the data,? he said.
The latest report on Star plan quality from the Centers for Medicare & Medicaid Services backs up the NCQA's findings. Clearly, money is motivating improvement. Health plans are earning more for Medicare patient health improvements; primary-care physicians are earning more for delivering better care; and health plans are reducing copays, offering free gym memberships and otherwise paying their members to stay or get healthy.
Clearly, these things could move the needle. In the end, we may spend a lot more money to improve health?just how it's done will be up for a lot of debate, even after the winner takes all on Nov. 6.
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