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

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PRESIDENT’S MESSAGE Dear Colleague: 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 • P R E S I D E N T ’ S M E S S A G E Every autumn, NCQA updates the nation on how consistently health plans deliver high-quality care. This, our 15th State of Health Care Quality Report, is a snapshot of an industry that is moving in the right direction, but has opportunities for further improvement. We find encouraging signs of rising quality. Across diverse measures of care, performance is improving, and insurers can be proud of what they have accomplished. We also note that some insurers are not reporting and that for some measures, we have not seen the gains in performance we would like. Three features distinguish this year’s report. first, it is longer than in past years because it includes, for the first time, comparisons between HMos and PPos across all measures. That we are able to fill a report with PPo data tracked over time is a significant step in quality’s story. Not long ago, few PPos quantified or disclosed results. Now, measurement and transparency are more common, though there is room to add more PPo reporting. The rising tide of PPo reporting is a credit to PPos that have worked hard to fashion themselves into data-driven organizations that collect and report results. Their willingness to evaluate themselves and be transparent is a boon to consumers, a third of whom are enrolled in PPos. A second distinct feature of this report is a focus on longer-term trends—a departure from our usual concentration on one-year changes in performance. In a fast-paced society where attention spans seem to grow ever shorter, it’s easy to overlook the cumulative benefits of determined, incremental gains. yet stepping back to look at the long term confirms that the industry has come far. The data show that insurers’ commitment to measurement, transparency and accountability has, over the years, improved care, saved lives and reduced suffering. finally, this report looks ahead to consider how quality measurement can help address what is arguably our country’s most ominous long-term threat—ballooning health care costs. It is important to grasp that the most insidious cost problems are often problems of quality— extra costs resulting from preventable medical errors, overtreatment and ineffective care. An 5
6 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 increasingly common response to the cost crisis is to drop coverage or increase deductibles, a reaction that can also be understood as a quality issue. After all, not having coverage is the ultimate quality gap. Reducing care as the main strategy for containing costs is a siren’s song: it might seem irresistible or inevitable, but it is ultimately destructive. A more sustainable approach is to stretch our health care dollars and get better results by emphasizing a value agenda. This report identifies ways that health plans can be catalysts to transform health care from a system that prizes volume to one that emphasizes value. In particular, we call on health plans to redefine their roles to take advantage of existing tools that can spur and complement delivery system reforms. These changes are important because value’s delicate intersection of cost and quality is no longer just nice to have; it’s a necessity. Thank you for your interest in these vital topics. And thank you for doing all you can to improve the state of health care quality.
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C o N S U M E R A N D P A T I E N T
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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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150 APPENDIx 6b: ACCREDITED VS. NoN
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152 APPENDIx 7A: PUblICly REPoRTING
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158 APPENDIx 8: PUblICly REPoRTING
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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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