The quality of care provided by health plans in America showed signs of improvement in 2005, according to the National Committee for Quality Assurance's 'State of Health Care Quality Report 2006,' which was released Sept. 27. The data included in the report came from more than 500 health plans in the country, but West Virginia did not have enough participating plans to generate statewide data, according to a representative from the National Committee for Quality Assurance, or NCQA.
Nationwide, NCQA President Margaret E. O'Kane said the data shows 'there is now in place a systematic assessment of health care quality in this country that did not exist a decade ago.'
'The rewards of this effort are substantial: Across nearly every dimension of care measured, performance has trended steadily, and in some cases dramatically, upward,' O'Kane said in her letter at the start of the new report.
Some of the most notable improvements in the new NCQA report involve health care for children. More than 77 percent of children enrolled in private health plans received all the recommended childhood immunizations in 2005, up from 72.5 percent in 2004. Within the Medicaid system, 70.3 percent of children were immunized, according to clinical guidelines in 2005, up from 63.1 percent in 2004.
Another encouraging statistic is that 75.5 percent of Medicare beneficiaries who smoke were told to quit in 2005, a gain of nearly 11 percentage points from 2004.
In addition, private health care plans in the U.S. saw improvement in 35 of 42 measures in the effectiveness of health care, such as controlling high blood pressure, comprehensive diabetes care and post-heart attack treatment. Among Medicare beneficiaries, however, health plans posted gains in only 10 of 23 measures.
In West Virginia, the Health Plan of the Upper Ohio Valley reported strong results in the area of childhood immunizations. The plan, which offers coverage from the Northern Panhandle to Preston County and down to Wood County, saw its child immunization rate jump from 64.85 percent in 2005 to 79.72 percent so far this year.
Optimum Choice Inc., which offers private health care coverage statewide, posts a 75.91 percent childhood immunization rate so far this year, up from 72 percent in 2004.
When it comes to controlling high blood pressure, the Health Plan's 73.2 percent rate in 2005 was better than the national average among commercial private health plans (68.8 percent). Optimum Care posted a 53.4 percent rate for that measure in 2005, but so far this year the provider is showing a 70.5 percent rate for controlling hypertension.
About 61.4 percent of Medicaid recipients had their high blood pressure controlled in 2005 - the same as in 2004. Medicare has seen a marked improvement in its ability to control high blood pressure in its patients, going from 61.4 percent in 2003 to 66.4 percent in 2005.
Recognizing diabetes early so patients can begin treatment to control symptoms is a recognized goal in health care. According to NCQA, health plan providers slowly are getting better at testing blood sugar levels.
More than 87 percent of diabetics in the country who are insured by commercial plans had their blood glucose levels tested in 2005, a full percentage point higher than in 2004 and two points up from 2003. The two West Virginia plans did not score quite as high in that area. Almost 83 percent of Optimum Care policyholders had their blood sugar tested in 2005, while 78.4 percent of Health Plan subscribers were tested that year.
Despite gains made, however, O'Kane last week said a recent health care 'scorecard' published by The Commonwealth Fund - a private nonpartisan health care research foundation shows Americans still do not get the best quality for their health care dollars. The scorecard estimated that if everyone with diabetes and high blood pressure had their conditions under control at the rates achieved by the top performing health plans, for example, it would save an estimated 20,000 to 40,000 lives and $1 billion to $2 billion each year.
