{news} Fw: Is NCQA's goal of quality attainable?

[Justine McCabe]

>From Don McCanne, MD,  president of Physicians for a National Health Program
which, like  USGP, advocates for a national single payer health insurance
plan.

======================================================
 National Committee for Quality Assurance (NCQA)
The State of Health Care Quality - 2004

 From the Introduction:

 NCQA is pleased to present its 2004 State of Health Care Quality report.
 This is the eighth such report NCQA has produced, and the fifth report in a
 row to find that performance on key measures of clinical quality has
 improved over the past year. For the 69 million people enrolled in the
 health plans that provided their performance data to help NCQA prepare this
 report, this trend is very good news; they can expect better care and
better
 health outcomes.

 But what of the rest of the health care system?

 What of those with little or no access to care such as the 45 million
people
 without health insurance? What of those who receive care through health
 plans that do not publicly report their performance? Using conservative
 estimates, this report finds that the performance of the rest of the system
 leaves much to be desired. Huge "quality gaps" exist, costing tens of
 thousands of lives, millions of illnesses and billions of dollars annually.

 From the Summary:

 Despite evidence of promising gains in certain sectors of the health care
 system, once again this year NCQA documented evidence of widespread,
 unexplained variation in quality that results in thousands of unnecessary
 deaths, tens of thousands of avoidable hospitalizations and illnesses and
 billions of dollars in lost productivity-hobbling an economy already
 encumbered by the ever-growing costs of health insurance.

 Even as adherence to evidence-based care has improved in many health plans,
 there is cause for great concern that these gains could be erased in the
 years ahead. The trend toward PPOs and CDHPs, while holding great promise
in
 terms of consumer engagement and harnessing of the Internet's power, also
 relies more on patient decision making and less on aggressive care
 coordination.

 http://www.ncqa.org/Communications/SOMC/SOHC2004.pdf


 Comment:  The abysmal quality of health care for the uninsured has been
well
 documented. And it is no surprise that quality can be improved for those
 individuals who have comprehensive health care coverage. Clearly we need to
 enact changes that would ensure that everyone has comprehensive health care
 coverage.

 What should alarm us about this report is the current trend in health care
 coverage. Because there is more flexibility in the design of PPOs
(preferred
 provider organizations), premiums can be made more affordable by shifting
 costs to the beneficiary-patient. Also, the CDHPs (consumer-directed health
 plans) are designed to make patients more responsible health care shoppers
 by exposing them to higher out-of-pocket expenses. But as the NCQA report
 indicates, this trend places a greater emphasis on patient decision making
 at the cost of deemphasizing aggressive care coordination.

 The great news about the NCQA report is that aggressive care coordination
 does improve quality outcomes. The NCQA report describes approaches to
 improve the identification of better outcomes through improved care
 coordination. A carefully designed system can be used to reward higher
 quality care. But PPOs and CDHPs, by shifting the direct spending decisions
 to the patient-consumer, also shift the responsibility for identifying
 quality to the patient. But our current fragmented system does not have the
 capability of providing readily accessible, easily understood data on
 quality variation. And limiting choice to health plans reduces the
patient's
 ability to have the more important choice of actual health care providers.

 A single, universal system with truly comprehensive benefits would provide
 an infrastructure that would enable the promotion of inducements that would
 encourage aggressive care coordination. We have enough data already to know
 what would happen with a greater shift to CHDPs and PPOs. We do not need
 another decade of health policy experimentation ending with the inevitable
 impaired outcomes.

 We also have enough data to know what a universal, comprehensive system
 would bring. Even the special interests opposing reform understand the vast
 superiority of the single payer model. So why do we continue to listen to
 and follow their rhetoric designed to protect their own interests? As we
 continue to postpone the inevitable, we are perpetuating suffering and
 death. The blood is on the hands of those who fail to act.