Health Plans’ Chronic Care Criticized
Many managed health plans fall short of the industry’s own targets for treating chronic illness and could be improved even in their traditional strong suit of preventive care, according to a comprehensive national study released Wednesday.
The survey of 329 managed care firms covering 37 million Americans found that only a small number of them deliver top-flight care to the vast majority of their patients. Managed care encompasses health maintenance organizations and preferred-provider networks, as well as other health group arrangements that control costs by restricting the use of specialists and sophisticated treatments.
Overall, the health plans prescribed “beta blocker” medication--considered vital for patients who have suffered heart attacks--to only 62% of patients for whom it would have been appropriate. Some plans prescribed it in as few as 15% of cases.
The report by the National Committee on Quality Assurance in Washington is based on detailed surveys that the health plans participate in voluntarily--motivated by the large employers who demand quality information to help them choose among health plans for their workers.
For the first time, the data make it possible to compare health maintenance plans by quality as well as by cost. Industry representatives expect that making the ratings public will push the plans to improve.
“Clearly, plans will want to do better,” said Susan Pisano, director of communications for the American Assn. of Health Plans.
Still, health policy experts caution that the public should be wary of reading too much into the ratings. One problem is that, although the survey is a crucial first step toward focusing employers and the public on quality, it has just one or two measures that monitor treatment of catastrophically sick patients.
“Most people say the most important thing is how a plan treats them when they are very sick. That’s what we hear the most complaints about and the NCQA doesn’t have many measures of how health plans are doing with that,” said Robert Blendon, a professor of health policy at Harvard University.
Referring to the information about prescription rates for beta blockers, Dr. Cary Sennett, chief physician of the National Committee on Quality Assurance, said: “If we could bring the industry up to the 90% benchmark we could save 100,000 to 200,000 lives a year.”
The categories surveyed included smoking cessation, childhood immunization, beta blocker medication, breast cancer screening and eye exams for diabetes patients.
On average, the plans counseled only 61% of smoking patients to quit, even though smoking is the country’s No. 1 preventable cause of death. About 65% of 2-year-old children had received all the appropriate immunizations. Diabetes patients, who are at risk of going blind, did particularly poorly in the plans, with just 38% receiving annual eye exams.
Plans did better in screening women for breast and cervical cancer: On average, 70% of women patients received screening for both. But pregnant women do the very best of all: 84% receive prenatal care in the first trimester of their pregnancies.
Overall, California managed care plans scored near the national average for most treatments. However, the Kaiser Foundation Health Plans for Southern and Northern California scored substantially above the state and national averages in several categories.
