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

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T H E S TAT E o f H E A l T H C A R E Q U A l I T y 2 0 1 1 • H E D I S M E A S U R E S o f C A R E looking at quality and resource use scores together, purchasers should be most interested in plans that are high in quality and low in resource use. As depicted in the following scatterplots, scores that place health plans in the upper left quadrant are generally considered most desirable (above-average quality, below-average resource use). Health plans in the lower right quadrant are less desirable (below-average quality, above-average resource use). This report focuses on the three rru measures where discrepancies between plans’ resource use and resulting quality are most pronounced: hypertension, diabetes and certain cardiovascular conditions. We do not show commercial rru scatterplots because they have changed little since last year’s State of Health Care Quality Report and are available in NCQa’s Quality Compass product. Conversely, we show Medicare and Medicaid results because we did not do so in last year’s report, and because the data are not available in Quality Compass. upcoming refinements to rru • Updated Risk Adjustment Approach: NCQa moved to an improved risk adjustment approach that was adapted from the Center for Medicare & Medicaid Service’s (CMS) hierarchical Condition Category (hCC) case-mix adjustment approach. The revised risk adjustment considers disease severity and number of comorbidities, in addition to other factors that inform the cost of care delivered to health plan members. • Measure Enhancement: NCQa expanded its measurement of specific procedures, particularly for diabetes and cardiovascular care, to provide plans with actionable information about the frequently performed services that significantly contribute to resource use. examples of these procedures include cardiac catheterization; carotid artery stenosis diagnostic tests; electron beam computed tomography and nuclear imaging stress tests for coronary artery disease; and cardiac computed tomography screening. reporting risk adjusted utilization of these services, alongside cost information, is expected to increase meaning and actionability of measure results. • Pharmacy Prescription Utilization: To provide more detail for the prescription drugs service category, NCQa added generic and name-brand utilization rates to the five measures. Compared with the previous format, the data now capture how well a plan manages its pharmacy costs with respect to generic, brand-name and multisource drugs. 31 S A f E T y A N D P o T E N T I A l W A S T E
S A f E T y A N D P o T E N T I A l W A S T E 32 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 Quality (Indexed Ratio) Quality (Indexed Ratio) 1.5 1 0.5 MEdICarE HMos: dIabEtEs 0.5 1 RRU (Indexed Ratio) 1.5 1.5 1 0.5 MEdICarE PPos: dIabEtEs 0.5 1 RRU (Indexed Ratio) 1.5
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128 N AT I o N A l C o M M I T T E
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130 APPENDIx 1: HEDIS EffECTIVENESS
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134 APPENDIx 2: HEDIS EffECTIVENESS
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172 MEASURE N AT I o N A l C o M M
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184 REfERENCES N AT I o N A l C o M
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ACkNoWlEDGMENTS Health Plans The 20
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Continuous Improvement and the Expansion of Quality ... - NCQA

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