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Health Care Quality in U.S. Not Improving, NCQA Says

By Katie Litvin, CQ Staff

October 22, 2009 -- For the third year in a row, the quality of health care in the United States has not improved, according to the National Committee for Quality Assurance's 2009 report released Thursday.

The group surveyed more than 900 health care plans—that cover 116 million Americans—and determined that the quality of commercial health insurance, Medicare and Medicaid, has not improved.

"The results of health care plans aren't moving forward as they have in the past," said Margaret O'Kane, the president of NCQA, during an event Thursday to release the report. "Everybody deserves to have the best health care. Quality needs to be the foundation of health care reform."

If all health care providers provided the same quality of care as the top 10 percent of plans, 115,300 deaths could be prevented in the United States, according to the report.

The health care quality plateau could be attributed to the struggling economy and budget shortfalls, according to Vernon Smith, a principal at Health Management Associates.

Budget shortfalls "have forced states to focus on keeping their heads above water instead of working on improvement of quality measures," Smith said.

When health care providers focus on cutting costs, they may focus less on improving performance, according to the report. For example, to keep costs down Medicaid this year did not enroll more people in drug and alcohol treatment programs or increase follow-up visits with patients hospitalized for mental illness, the report said.

It also found that although the United States spends twice as much as any other nation on health care, there is little to no connection between health plan spending and quality of care received.

NCQA's evaluation of money spent on areas of care, such as diabetes and asthma, showed that some inefficient plans overspend with varying performance and other plans bring improved performance at a lower cost.

"You can't assume that because you're paying more for a health plan that you're getting a better product," said O'Kane. "This is why we must tie payment to performance."

Instead of increasing costs to improve health care quality, the chief medical officer of one health provider suggested improving the general health of the population, enhancing patient experience and reducing or controlling the per capita cost of health care coverage.

"We need to change the lifestyle habits that largely contribute to chronic disease," said Nancy Van Vessem of Capital Health Plan. "We have to get some consistent message out there, that's the key to improving the health of the country."

Smith warned against federal regulators mandating quality improvement programs from states because states can self-direct these programs and have individual fiscal limits. He said proposals to overhaul health care should envision a greater role for Medicare and Medicaid, and ensure that all spending required in legislation is well spent.

"I do not expect the plateau to continue, because commitment to improvement is solid," he said.

The plateau in health care quality should be addressed in health care overhaul legislation, O'Kane said. NCQA's report found currently 60 percent of Americans are not covered by an accountable health care plan and that health care quality varies widely by geographic region.

The report found that the Deep South and South Atlantic regions of the United States experience worse health care quality levels than the national average. Diabetes care in the South central region of the country is 5.3 percentage points below the national average for health care quality, the report found.

"Vulnerable populations are not seeing the improvements that we'd like to see," O'Kane said.

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