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Medical care quality rises, but wide disparities remain

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WASHINGTON--Though the quality of medical care provided by health plans participating in the National Committee for Quality Assurance's annual quality reporting initiative continued to improve last year, mental health care quality remains as poor today as it was a decade ago.

And enormous differences persist between the performance of the nation's health care system as a whole and the top accountable health plans, "The State of Health Care Quality: 2006" report has found.

Antidepressant medication management actually deteriorated between 1998 and 2005, the NCQA discovered. While 20.6% of health plan members received optimal practitioner contacts in 2005, a slight improvement from 20.0% in 2004, that figure was down from 22.7% in 1998.

Effective treatment

Effective depression treatment would save employers more than $30 billion per year in lost productivity, the NCQA estimates. In addition, total medical costs are reduced in patients remaining on antidepressants for at least 90 days, according to the NCQA.

The NCQA estimates that if the entire U.S. health care system performed at the level of the top reporting plans, between 37,600 and 81,000 lives would be saved, $10 billion in lost productivity would be regained and almost 65 million sick days would be avoided.

Among the most significant gains in NCQA's 2005 report:

  • 77.7% of children in commercial health plans received all recommended immunizations, up from 72.5% in 2004 and nearly three times the proportion reported eight years ago.

  • Diabetics are more than twice as likely to have their cholesterol controlled to recommended levels as they were in 1998. In 2005, 67.5% of diabetics' cholesterol was being controlled vs. 64.8% in 2004 and 29.1% in 1998, the first year this protocol was measured by the NCQA.

  • 96.6% of patients in commercial health plans who suffered a heart attack were prescribed beta-blockers to help prevent a second, often fatal heart attack, up from 96.2% in 2004 and only 62.6% in 1993, the first year the treatment was measured.

    Because of enrollment shifts away from traditional managed care plans, only one in four Americans are currently enrolled in health plans that collect and report data on the quality of care, the NCQA pointed out, noting that this trend could have a detrimental effect on quality improvements since public reporting has been found to promote improvements in the quality of care.

    However, the NCQA has stepped up efforts encouraging reporting by preferred provider organizations and other types of health plans. In response, 80 commercial PPOs participated in the 2006 Health Plan Employer Data and Information Set, or HEDIS, report compared with only a handful for which only partial data was reported last year.

    A total of 76.5 million Americans are enrolled in health plans that participate in the NCQA's annual measurement project, up from 64.5 million in 2004.

    New federal requirements that Medicare Advantage PPOs and federal government employees' health plans report on HEDIS measures are also expected to boost participation.

    Still, more than 100 million insured Americans are enrolled in plans that do not report to the NCQA.

    "The State of Health Care Quality: 2006" may be downloaded at no cost from the NCQA Web site, www.ncqa.org.

    Print versions can be purchased by calling 888-275-7585.