Health care: You don't get what you pay for

By Parija Kavilanz, senior writer

NEW YORK ( -- Health plans that allow for many tests, doctor visits and hospital stays don't necessarily deliver the best quality of care for the cost, according to a new industry report Wednesday.

This was one of the key findings in the 14th 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.

More use of health care resources, such as inpatient bed days or procedures, can actually be associated with poorer quality, said Greg Pawlson, executive vice president of research with NCQA.

While the saying "you get what you pay for" makes sense in many fields, the report said it doesn't apply as neatly to health care.

"Areas in the country where health plans allow for greater use of health care resources don't always deliver better quality of care compared to other areas where the use of resources is less," said Pawlson.

With Medicare usage for example, Pawlson said data shows that Miami has a very high utilization rate but the quality of care is about the same as in Minnesota a lower health care spending area.

The report examined the performance of more than 1,000 managed care plans that voluntarily submitted information on quality of care, access to care and member satisfaction.

In total, these plans cover more than 116 million Americans.

Role of reform. Overall, the report showed that the quality of health care for millions of Americans insured through commercial or public plans did not meaningfully improve for the second straight year.

"In 2008, health plans also flatlined for the first time in 13 years in improving quality of care. At the time, it wasn't clear if there was anything in the future that would change that outcome," said Greg Pawlson, executive vice president of research with NCQA.

But now with the advent of health reform, Pawlson said there is an opportunity for insurers to improve the quality of care, patient experience and the total cost of care.

New provisions under reform will push insurers more than ever before to improve the quality of their health plans, said Sarah Thomas, vice president of public policy with NCQA.

For example, beginning in 2012, health plans will be mandated to report their quality of care scores.

Also, beginning in 2014, health plans will have to meet high standards to be included in health insurance exchanges.

Thomas said these measures will challenge health plans to invest in quality, better manage their costs and compete for new members based on patient experience and premiums.

First-time drop in children's vaccination rates. The report also showed a first-time decline -- about four percentage points -- in childhood vaccination rates among enrollees of commercial plans.

"This was a sobering and surprising finding," said Pawlson. "We've never seen this downward trend before in commercial plans other than when there are vaccine shortages."

At the same time, childhood vaccination rates increased by almost three percentage points among Medicaid enrollees.

Pawlson said medical experts explain that failure to vaccinate children is typically associated with lower-income families. However, the recent trend in delaying or refusal to vaccinate children is becoming more common among higher-income and higher-educated households.

The report said media reports and activist efforts in recent years speculating on a "discredited" link between vaccines and autism could be one plausible reason for the decline in vaccination rates in 2009.

Pawlson said the Center for Disease Control and Prevention is concerned that this downward trend could result in viral disease outbreaks, especially among children in lower-income populations.

In other areas, there were slight declines in consumer experience with care delivered through their health plans. Also for the first time, the report noted a decline in satisfaction with specialist physician services.

Insurers did log some progress, however, including improvement in colorectal cancer screening for commercial plans and in eye exams for diabetic patients in Medicare plans. To top of page

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