Health Care Quality Up Among Reporting Plans; Enrollment Continues to Shift Toward Consumer-Driven Plans

October 4, 2005

Health care quality improved markedly in many key areas in 2004, but only about 21.5 percent of the industry now reports publicly on its performance, according to NCQA’s annual State of Health Care Quality report.

Among the 289 commercial health plans that reported their data, average performance improved on 18 of 22 clinical measures. Medicare and Medicaid plans reported smaller gains. The report shows that as many as 67,000 deaths have been prevented to date as a result of improvements recorded over the past six years.

Especially notable this year were improvements in measures related to high blood pressure control (up 4.6 points to 66.8%) and cholesterol control for people with diabetes (up 4.4 points to 64.8%).

“This is a positive trend that can continue indefinitely, but the price is that we have to pay attention and reward accountability,” said NCQA President Margaret E. O’Kane. “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?”

These improvements are enjoyed by about 64.5 million Americans, which represents a decline of 4.5 million from a year ago, due largely to shifting enrollment patterns. Enrollment in PPOs and high deductible (consumer-directed) health plans is up sharply; with few exceptions, these plans tend not to measure or report on their performance.

Variations in quality remain commonplace. In New England, about 71 percent of patients with hypertension have their blood pressure under control. In the Mountain region however, the rate is only about 62 percent.

“If you are a Medicare enrollee living in Fort Wayne, Indiana, you are five times more likely to get a spine fusion than a similar enrollee in Terre Haute,” said Elliott Fisher, M.D., M.P.H., Dartmouth Medical School. “These remarkable differences in practice show that what’s best for the patient isn’t always what drives clinical decisions.”

The report also estimates that between 39,000 and 84,000 Americans die each year due to commonplace failures to provide recommended care. For example, it is recommended that diabetics receive medication and support to control their blood sugar, but only about 70 percent actually have their blood sugar controlled. This results in nearly 12,000 avoidable deaths each year; businesses lose $13 billion in productivity annually.

NCQA and U.S. News & World Report have collaborated to create new rankings of America’s Best Health Plans. The print version of the U.S. News/NCQA America’s Best Health Plans rankings includes 50 commercial, 25 Medicare and 25 Medicaid health plans, but virtually every plan in the nation–ranked based on clinical performance, member satisfaction and NCQA Accreditation–is included online at

The report is available online at

Was this article valuable?

Here are more articles you may enjoy.