Quality of U.S. Health Care Stuck in Neutral

Analysis shows spending unrelated to quality improvement.

(NCQA: Washington) -- “The State of Health Care Quality 2009,” an annual report, now in its 13th year, provided by the National Committee for Quality Assurance (NCQA), finds that the quality of U.S. health care was virtually stagnant in 2008, a disturbing slowdown after a decade of improvements. The across-the-board trend was seen in care provided to people with private insurance coverage as well as in Medicare and Medicaid. The report also examines the link between higher health care spending and quality and finds little to no connection, a finding with significant implications for health care reform efforts.

“As Congress works to shape a final health reform bill, lawmakers must be certain that the legislation includes significant provisions to improve the quality and efficiency of care,” says NCQA president Margaret E. O’Kane. “This includes requiring quality reporting by all health plans and providers, not just those who do so voluntarily today.”

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NCQA Rates Neutral - Not Surprising

A lot of the improvements made in the past were due to better data collection by health plans. As an example, by having better electronic health records and database systems, cancer screening rates were improved by capturing a larger numerator vs the denominator of the eligible patient population. Certified software vendors that take the data from health plans and calculate the measures have certainly helped rates improve over the last ten years. In sum, the rates never really changed that much, but the capture of the data improved.

Also, changes in the technical specifications of NCQA has in some cases caused improvement trends to take place when really there wasn't much improvement taking place.

NCQA will need to examine health plan influence on quality of care delivered by provider networks. Are health plans the right entities to promote quality with providers? Maybe if they are integrated with a delivery system??? I would not expect any significant improvements to take place going forward if NCQA holds its current course and methods of measuring quality.