Immunization rates for infants and toddlers in commercial health plans declined in 2009, as did patient satisfaction with health plan performance, while other quality measures rose markedly, according to a yearly accounting compiled by the National Committee for Quality Assurance.
The data for the NCQA State of Health Care Quality Report came from 1,000 HMOs and PPOs providing coverage for about 118 million U.S. residents insured by Medicare, Medicaid, or a private health plan. This is the 14th year that NCQA has compiled and analyzed data from its Healthcare Effectiveness Data and Information Set (HEDIS), which managed health plans use to measure their own performance.
In 2009, there was a “disturbing drop in commercially insured immunization rates,” most likely resulting from the “suburban legend” that vaccinations are linked to autism, said NCQA President Margaret E. O’Kane during a briefing Oct. 13.
Under Medicaid plans, childhood immunization rates improved by 1% from 2008 to 2009 to about 70% coverage; however, coverage in private plans declined 4% to about 72% coverage.
“The drop in childhood vaccinations is disturbing because parents are rejecting valuable treatment based on misinformation,” said Ms. O’Kane.
Patient satisfaction with private plans declined slightly, and was low compared with that of the public plans, according to Ms. O’Kane.
In 2009, about 60% of beneficiaries gave Medicare high marks, compared with 51% of Medicaid recipients and 39% of private health plan patients, according to data gleaned from the federally funded Consumer Assessment of Healthcare Providers and Systems survey.
Those rates have been somewhat steady since 2007, but Ms. O’Kane said she thought that attacks on health insurers during the health reform debates may have led to greater negative impressions of the private plans.
The report also covered a number of medical care measures. For example, beta-blocker use after myocardial infarction rose across all types of insurers, with 82% of those in Medicare plans receiving the treatment, compared with 76% of those on Medicaid and 74% of commercial patients. Colon cancer screening also rose, as did screening for chlamydia, with Medicaid plans screening 57% of patients for that sexually transmitted disease, compared with 43% of commercial plans.
The report tallied the lives and dollars saved from improvements on the five most costly conditions. By improving beta-blocker treatment, cholesterol management, blood pressure control, hemoglobin A1c management, approximately 272,000 to 1.7 million lives were saved, according to the report.
Adding in measures such as breast cancer screening, smoking cessation, and osteoporosis management led to some $2.4 billion to $6.5 billion in hospital savings, Ms. O’Kane said.
Areas for improvement included preventing falls and reducing inappropriate use of imaging for lower back pain, she said.
Physicians can have a huge impact on fall prevention, she said, noting, however, that the report found only about a third of Medicare patients discussed falls or gait problems with their physicians in the last year. That number has been unchanged the last several years. Evidence-based guidelines suggest that older people should be asked about falls once a year and should receive an assessment or advice on how to avoid falls.
“We’re not taking this seriously enough,” Ms. O’Kane said.
The full report can be found at www.ncqa.org.