NCQA: Enrollment down, quality up in health plans that report on performance
Credentialing Resource Center Connection, December 1, 2005
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The National Committee for Quality Assurance (NCQA) detailed increased quality and decreased enrollment in national health plans that report on performance in its annual State of
About 64.5 million Americans are covered by publicly reporting plans, a decline of 4.5 million from a year ago. The drop is largely due to shifting enrollment patterns, according to the NCQA. PPOs and high deductible health plans, which tend not to measure or report on their performance, have dramatically increased enrollment, causing less performance information to be available to the public.
"Any kind of health plan might potentially be an excellent plan, but realistically, only the ones that measure quality are going to achieve excellence," said NCQA president Margaret E. O'Kane, in a written statement. "The new mantra for health care purchasers needs to be, 'show us your data.' Why trust your family's health to an organization that operates behind closed doors?"
Of the 289 commercial health plans that did report their data, average performance improved on 18 of 22 clinical measures, while Medicare and Medicaid reported small gains. To date, as many 67,000 deaths have been prevented as a result of improvements recorded over the past six years, according to the report. Improvements in measures related to high blood pressure control and cholesterol control for people with diabetes were most notable.
Download the complete report at www.ncqa.org.
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