November 2007: Volume 33, Number 11
Improvement in Healthcare Quality Slowed in 2006
Even though more health plans are reporting quality measures and the overall quality of care in America improved in 2006 for the eighth consecutive year, the annual State of Health Care Quality report released by the National Committee for Quality Assurance (NCQA) also noted a relatively sluggish rate of improvement over past years, as well as a lingering gap between top performing providers and the healthcare system as a whole.
The report accounted for the increase in the total number of health plans reporting quality measures by highlighting a sharp increase in the number of preferred provider organizations (PPOs) that reported quality data. A total of 141 PPOs submitted HEDIS data in 2006, an increase from the 80 PPOs that submitted in 2005. Areas that helped contribute to the overall increase in quality of care included colon cancer screening for adults over 50 (See Graph, below) and widespread use of beta blockers for heart attack patients.
Commercial health plans posted improvements in 30 of 44 HEDIS measures of effectiveness of care, including gains in childhood immunizations and colorectal cancer screening. Medicaid plans improved in 34 of 43 measures. However, private plans participating in Medicare improved in only eight out of 21 measures of care—the second consecutive year that Medicare plans did not improve in a majority of areas NCQA measured.
The NCQA report said that the slower gains in quality compared to past years was in part due to high levels of performance in areas that have been measured for many years, such as beta-blocker treatment after a heart attack and HbA1c testing in diabetes care. The higher average quality in these areas leaves less room for further improvement. But an analysis comparing the top 10% of healthcare plans to the system as a whole reveals a more than $2 billion shadow cast by unexplained variations in care. Though NCQA puts these estimated avoidable hospital costs in the $2.7–$3.7 billion dollar range, more disturbing is the number of avoidable deaths due to low-quality care—somewhere between 35,000–75,000. The report is available online.