What NCQA thinks about qual­ity

… but some in­sur­ers still won’t pub­licly re­port data

Modern Healthcare - - FRONT PAGE - Mau­reen Mck­in­ney

Health plans’ qual­ity im­prove­ment ef­forts are yield­ing steady per­for­mance gains, but some in­sur­ers still refuse to pub­licly re­port their data, ac­cord­ing to an an­nual re­port from the National Com­mit­tee for Qual­ity As­sur­ance.

In its State of Health Care Qual­ity 2011 re­port, re­leased Oct. 13, the Washington-based not-for-profit health­care qual­ity and ac­cred­i­ta­tion or­ga­ni­za­tion noted across-the­board im­prove­ments in ar­eas such as col­orec­tal can­cer screen­ing, and it em­pha­sized the grow­ing need for in­sur­ers to rede­fine them­selves as driv­ers of qual­ity and value.

“Plans are wak­ing up to the fact that there are so many op­por­tu­ni­ties to im­prove,” Mar­garet O’Kane, the NCQA’s pres­i­dent, said in an in­ter­view. More in­sur­ers are fo­cus­ing on ar­eas such as chronic dis­ease man­age­ment, and are work­ing with providers to curb rates of pre­ventable hos­pi­tal read­mis­sions, she said.

For the re­port, the NCQA an­a­lyzed data on re­source use, pa­tient sat­is­fac­tion and clin­i­cal qual­ity, vol­un­tar­ily sub­mit­ted by more than 1,000 health plans—740 HMOs and 302 pre­ferred provider or­ga­ni­za­tions. This re­port also marks the first time the NCQA in­cluded PPO data for com­par­i­son with HMOs across all of the NCQA’s Health­care Ef­fec­tive­ness Data and In­for­ma­tion Set mea­sures.

And although HMOs have tra­di­tion­ally led in health­care qual­ity, the data showed that PPOs have made sig­nif­i­cant jumps in per­for­mance in many ar­eas, O’Kane said. For in­stance, com­mer­cial HMOs and PPOs had nearly iden­ti­cal scores—92.9% and 93%,

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