NCQA Annual Health Report

Based on data collected for the 2011 year, the latest National Committee for Quality Assurance annual report paints a picture of continuing improvement in American health care quality, at least according to the measures the group uses.   (NCQA Report)   The report includes health plans covering 125 million people.  One of the areas of focus in the report is obesity and the current year shows a large jump in the number of persons who had a body mass index performed and for children, an increase in nutritional and exercise counseling.  Another area highlighted was the improvement in performance on measures included in the STARS rating for Medicare Advantage plans.  Since CMS pays bonuses to high-scoring plans, it is no surprise that plans are doing better on these measures.  In addition to BMI assessment, other areas of strong improvement include smoking cessation, colorectal cancer screening and hypertension control.  The rate of inappropriate use of high-risk medicines in the elderly dropped.

Performance is quite high on a number of the measures and has been there for a while, so further gains are difficult.  And  some populations, for example Medicaid beneficiaries, can be refractory and it may be unrealistic to expect the patient compliance that is necessary, for example in regard to immunizations.  In general, for commercial health plans, their relative performance tends not to change over time.  So even though their performance may improve over time, plans in the lowest quintile of performance tend to stay there and plans with high relative performance tend to keep that status.  Not that they have a vested interest, but the Committee also notes that NCQA accredited plans are better performers than non-accredited ones.  And Medicare Advantage plans have continued to show great improvements, and probably are providing significantly better quality on these measures than is fee-for-service Medicare.  One big caveat to all of this is that these NCQA measures are not necessarily well proven to be correlated with actual outcomes.  So the measure scores may be better, but it is not clear patients’ health has actually improved.