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The quality of managed care organizations varies greatly across the country and even within regions in terms of preventive care, treatment of acutely and chronically ill patients, and member satisfaction, a new report shows.
However, in many cases managed care plans provide better care than traditional fee-for-service medicine, according to the first annual "State of Managed Care Quality" report released last week by the National Committee for Quality Assurance.
The Washington-based NCQA and its supporters hope the new data will provide a starting point for true benchmarking of the managed care industry.
Benefit managers were enthusiastic about the survey.
"I love the report," said Helen Darling, manager of international compensation and benefits for Xerox Corp. in Stamford, Conn.
"We've known about these variations for years, but to see actual data finally is gratifying," she said.
And, once the word spreads, Ms. Darling believes the quality of care delivered by all plans-including fee-for-service-will improve.
"Once this information gets out on a plan-specific basis, it will change the system," she said. "This shows the power of good managed care to actually raise the level of care in this country so that the people in rural Mississippi get the same quality care as people in Boston."
The report also showed that there is no correlation between the cost and quality of health care in this country, she said.
For example, while the premium for the health maintenance organization with which Xerox contracts in Oklahoma City is its second-highest, the NCQA report found that the South Central Region had the lowest rate in many of its performance measures.
"Cost doesn't seem to have a bearing" on the quality of care, Ms. Darling said. "It seems to be more related to whether providers have any competition."
In fact, "one of the lowest premiums Xerox pays is in Southern California," where the cost of living is among the highest in the nation, she observed.
Maureen Coleman, manager of flexible benefits for AlliedSignal Inc., agreed.
"At a minimum, at least we're seeing health plans embrace the concept that quality will lead to cost-effectiveness," Ms. Coleman said.
NCQA President Margaret E. O'Kane said during a news conference last week announcing the findings that "the range of health plan performance across the country, and even within regions is striking."
For example, even though scientific studies have shown that treating heart attack patients with beta blockers saves lives, in some plans fewer than 30% of such patients receive them, she said.
"If we could bring the industry up to the 90% benchmark, we could save 100,000 to 200,000 lives a year," estimated Dr. Cary Sennett, chief physician of the Washington-based organization. Beta blockers reduce the likelihood of death by reducing blood pressure and slowing the heart rate, he explained.
Heart disease is the No. 1 cause of death in this country, killing about 500,000 people annually, according to Dr. Sennett, who also spoke during the press conference.
On average, U.S. managed care plans prescribed beta blocker medication to just 62% of the patients for whom it would have been appropriate, the report found.
By comparison, the rate of beta blocker treatment in fee-for-service plans is just 25%.
The report is based on detailed surveys of 329 managed care plans that participated in Quality Compass. While Quality Compass uses standardized information on more than 50 measures from NCQA's Health Plan Employer Data and Information Set (HEDIS 3.0), the new report focuses on eight measures the NCQA believes serve as important probes into the industry's overall performance.
The NCQA hopes the data it has collected for this first report will be used as a gauge for managed care plans to use in measuring the quality of the care they deliver and establishing improvement goals.
"We feel that today is a real watershed," said Ms. O'Kane.
In all but two cases-childhood immunizations and overall member satisfaction-NCQA also compared the performance of managed care against fee-for-service medicine.
In its report, the NCQA warned that because measures used for comparing managed care and fee-for-service were not identical, conclusions about the overall quality of the two delivery systems cannot be drawn yet.
Still, Dr. Sennett asserted that so far "the data that NCQA collected showed that fee-for-service care is not as good as managed care in many cases."
The areas the report surveyed:
Advising smokers to quit. The New England region scored the highest, with plans there reporting that providers advised 66.7% of adult smokers to quit. By comparison, plans in the Mountain region advised smokers to quit just 56.4% of the time. The national average is 61%. In fee-for-service, providers advised smokers to quit 37.2% of the time.
Cervical cancer screening. Once again, the New England region reported the highest rate-76.5%-of women in the plans ages 15 to 34 who have had at least one Pap smear during the past three years, while South Central had the lowest rate of 67.3%. The national average is 70.4%, and the fee-for-service rate was just 53%.
Beta blocker treatment after a heart attack. New England reported the highest rate, with 77.1% of those who had a heart attack leaving the hospital with a prescription, while South Central had the lowest rate of 55%. The national average is 61.9%, and the fee-for-service rate was just 25%.
Caesarean section. The Pacific region reported the lowest rate of C-sections, at 16.9% of women who had a live birth in 1996, while South Central had the highest rate at 23.9%. The National average is 20.6%, and the fee-for-service rate is 29.1%.
Breast cancer screening. New England had the highest rate, with 74.6% of women between the ages of 52 and 69 in the plans having had at least one mammogram during the prior two years, while South Central had the lowest rate, 68%. The national average is 70.4%, and the fee-for-service rate was just 50%.
Childhood immunizations. New England reported the highest rate, 80.7%, of children in the health plan who received appropriate immunizations by their second birthdays, while South Central had the lowest rate of 58.5%. The national average is 65.3%.
Eye exams for patients with diabetes. New England reported the highest rate, 50.4%, of plan members with diabetes age 31 and older who received an eye exam in 1996, while South Central had the lowest rate, 32.6%. The national average is 38.4%, and the fee-for-service rate was just 11%.
Prenatal care in the first trimester. The West North Central region scored the highest, with 89.1% of women in the plan beginning prenatal care during the first 13 weeks of pregnancy, while, once again, South Central scored the lowest, 81.9%. The national average is 84.5%, and the fee-for-service rate is 76%.
Overall member satisfaction. New England plans have the highest satisfaction rate, 62.9%, while plans in the Mountain region scored the lowest with 52.5%. Nationally, 56.2% of members indicated they were "completely" or "very" satisfied with their current managed care plan.
The NCQA noted that the rates may seem low because previously overall satisfaction ratings included in the Quality Compass included members indicating that they were "somewhat" satisfied. The organization changed the way it reports this data this year to make it more useful in distinguishing among plans.
The NCQA did not collect similar satisfaction data on fee-for-service plans.
The "State of Managed Care Quality" report is available online on the NCQA's Internet World Wide Web site at http: www.ncqa.org. "Quality Compass 1997" is available on CD-ROM for $2,500. Electronic data files-two of which contain plan-specific data, and a third containing summary statistics-cost between $2,500 and $5,000, depending on which type of data the user requires. Both the CD-ROM and electronic data files are available through NCQA's Publications Center at 800-839-6487