Insurers not improving nation's health care

New industry report: Health plans have flatlined on improving quality of care for the most prevalent conditions for the first time in 13 years.

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By Parija B. Kavilanz, senior writer

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NEW YORK ( -- The quality of health care for millions of Americans insured through commercial or public plans has stopped improving for the first time in more than a decade, according to an industry accreditation group's report issued Thursday.

The across-the-board trend in care quality provided to people with private coverage as well as in Medicare and Medicaid was virtually stagnant in 2008, according to the 13th annual "State of Health Care Quality" report from the National Committee for Quality Assurance (NCQA).

The NCQA is an independent non-profit association that accredits and certifies health care organizations and physicians on patient experience and delivery of clinical care.

"This breaks a 12-year run of significant progress," Margaret O'Kane, NCQA's president, wrote in the report. "While it could be a one-year blip, I fear it may be the beginning of a troubling trend."

"Commercial health plans, with a significant push from large employers, have achieved some remarkable results year after year," she said. "But [in 2008], that progress has halted."

Also troubling, the report noted, was the third consecutive year of "meager progress" in quality for Medicare and Medicaid beneficiaries served by health plans.

Overall, the report found that the quality of care for many health conditions -- including mental health and diabetes care -- declined, and that overuse of imaging for lower back pain and breast cancer screening grew.

The report also showed that only 34.1% of children prescribed medication to treat attention deficit hyperactivity disorder (ADHD) are seeing a doctor for follow-up care.

Failing to improve

Richard Sorian, vice president of public policy with NCQA, said two key factors -- the economy and health care's pay-for-service model -- have hurt the performance of health plans.

"In many cases employers and health plans have taken their eye off quality to focus on cost-cutting," Sorian said. And with health care's pay-for-service model, Sorian said there's no incentive to improve the quality of care.

NCQA assesses quality in terms of whether an insured patient is getting the right care at the right time.

"For example, we look at child vaccination rates before the age of two," explained Sorian. "Of those kids covered by a health plan, what percentage got these vaccinations. It's a clear black-and-white measure."

The report examined the performance of 979 managed care plans that voluntarily submitted information on quality of care, access to care and member satisfaction. In total, these plans cover about 116 million Americans.

"No segment of health care is more committed to advancing quality than insurers," said Susan Pisano, a spokeswoman for America's Health Insurance Plans, a group representing the industry.

"The fact that 979 plans covering 116 million people publicly reported their scores and have been doing so over the past 10 years, with significant year-over-year improvement [in the scores] is proof," said Pisano.

But she added that other players in the health care system, primarily providers, should also report their quality scores publicly and be held accountable. "Without accountability from all, there's a limit on what can be achieved in terms of quality improvement," she said. "It should not be health plans alone that are driving the quality agenda."

Insurers did log some improvements, including "near universal high-quality care" for Americans with asthma and a 12 percentage-point increase in the number of Medicare beneficiaries who persistently received essential medication for six months after a heart attack.

Sorian worries that by insurers failing to improves their quality grades, it means that consumers are not getting care at the right time.

"The consequence of this is that their health suffers," he said. "Consumers need to be more demanding of the system."

But falling grades also hold serious consequences for health plans, he said. "Many insurers have large corporations such as Fortune 500 companies as their clients," he said. "Companies build performance measures into their contracts with insurers."

So if an insurer's quality grades are falling, Sorian said clients can withhold part of the premiums they pay to insurers or take their business elsewhere.

"Failing to improve their [quality] grades is a very serious issue for everyone," said Sorian. To top of page

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