Results of the National Committee for Quality Assurance's (NCQA) annual State of Health Care report indicated that while quality measures overall remained static from 2009 to 2010, some significant gains were made by preferred provider organizations (PPOs).
"PPOs are definitely catching up," said Margaret O'Kane, NCQA president during the introduction of a briefing on the report's release that was broadcast live on the web. "(An) unmistakable and positive trend we see: Health plans have made remarkable quality gains over the years."
"When I look at the resources available to the well-known brand insurers, I don't think it is unreasonable to expect them to be better than average," said John Santa, MD, one of the briefing's panelists and Consumers Reports Health Ratings Center director. "If they can advertise in the fourth quarter of Notre Dame football games, they should have the resources needed to get 80 to 90 percent of their members with hypertension adequately treated. We need to keep track of both the score in the last two minutes of
Notre Dame games and the score in terms of how often is hypertension being adequately treated."
NCQA's State of Health Care report strives to report on documented performance trends over time. It tracks variations in care and offers recommendations in quality improvements.
This year's report's findings include:
• Medicare outperforms commercial plans on several intermediate outcome and process measures.
• Medicaid performance tends to be worse than commercial or Medicare performance.
• Childhood immunizations are still down in commercial health plans but are holding steady in Medicaid.
One of the most notable findings from this year's report is that while the performance of HMOs is generally higher than PPOs, PPOs have made strong gains in quality measurements and in some cases come abreast of HMOs. This year's survey of measures of care was the first time PPOs have been publicly compared to health maintenance organizations (HMOs) across all measures of care in the report's history.
"We firmly believe we're in a point in time today, certainly in our region and I believe in the country in general, where the movement to quality is essential to lower costs," said one of the briefing's panelists, John Bennett, MD, president and CEO, CDPHP Health Plan. "I do not in any way believe that we have to sacrifice quality to have lower costs. I think we're at a point in time in this country where our value equation is so distorted that clearly higher quality will lead to lower costs."