Continuous Improvement and the Expansion of Quality ... - NCQA

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N AT I o N A l C o M M I T T E E f o R Q U A l I T y A S S U R A N C E
Comparisons across product line—Commercial, Medicaid and Medicare product measures
reflect varying policy and population differences, but we can compare performance on measures
reported by all product lines. on these measures, Medicaid performance tends to be worse than
commercial or Medicare performance. Exceptions are Chlamydia Screening for Women and
Persistence of Beta-Blocker Treatment After a Heart Attack. one reason for Medicaid’s lower
performance might be that its population faces challenging economic circumstances; for example,
transportation to doctor appointments may be an issue. Even though this pattern holds for the
overall population, we do see some Medicaid plans with very high performance, suggesting that
some of the challenges of caring for this population may be surmountable.
Medicare and commercial performance relative to each other varies by measure. Medicare
outperforms commercial plans on several intermediate outcome measures and process measures.
Comparison With last year’s findings
Childhood immunizations—In last year’s State of Health Care Quality report, NCQA noted a
significant drop in childhood immunizations in commercial health plans. This drop also appeared
in the Centers for Disease Control and Prevention’s national data. Reasons for the drop include
widespread concern about the (disproven) potential for some immunizations to lead to autism;
other explanations were the rise in cost sharing and the economic downturn. The 2010 data do
not show a full recovery for commercial health plans. The Combination 2 Childhood Immunization
Rate for commercial HMos had a slight uptick, but the numbers were not statistically significant.
Medicaid results held steady. There was a drop in the H influenza type b (Hib) immunization
rate, which might have been caused by a temporary shortage of vaccine, and a small gain in the
polio (IPV) immunization rate.
overall pattern 2009 to 2010—Although several measures showed important gains—including
Colorectal Cancer Screening, Use of Spirometry Testing in the Assessment and Diagnosis of COPD
and Pharmacotherapy Management of COPD—many measures showed little meaningful change.
Commercial and Medicare PPos displayed significant performance improvement and showed
progress in closing the performance gap with HMos.