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NCQA Results Paint Murky Picture Of Health Plan Performance

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U.S. consumers may have been less satisfied with their health plans in 2006 than they have been since 2002, but the apparent drop may be due to a survey change.

Researchers at the National Committee for Quality Assurance, Washington, have published the 2006 plan member satisfaction figures and many other 2006 health plan performance statistics in their latest health plan quality report.

The NCQA bases the results on data from the Healthcare Effectiveness Data and Information Set care quality survey program and the Consumer Assessment of Health Providers and Systems member satisfaction survey program.

This year, changes in the member satisfaction survey and in the definitions for many important quality indicators, such as the indicator for breast cancer screening rates, make 2006 results hard to compare with earlier results, NCQA officials say.

The new version of the commercial plan member satisfaction survey has a different number of core items, and the wording of some returning items has changed.

Medicare program administrators have not yet released any satisfaction data for Medicare Advantage plans, NCQA officials say. It is possible that the characteristics of participating Medicare Advantage plans have changed in ways that affect comparisons of 2006 care quality data with prior-year data even when the indicators themselves have remained the same.

But the raw satisfaction figures for participating commercial plans show that only 73.6% of members gave their plans a rating of 8 or higher on a 10-point scale in 2006, down from 78% in 2005, according to the authors of the NCQA assessment.

The percentage of participating Medicaid plan members giving plans a rating of 8 or higher fell to 65.6%, from 72.8%.

Participating commercial plans reported improvements in 30 of 44 care quality indicators, and Medicaid plans reported improvements in 34 of 43 quality indicators.

Participating Medicare Advantage plans reported improvements for only 8 of 21 indicators.

Medicare Advantage plans told the NCQA they did a better job of managing osteoporosis and screened more older members for glaucoma.

But the care quality results show that the Medicare Advantage plans participating in 2006 were less likely to provide eye exams for patients with diabetes than in 2005.

The Medicare Advantage plans said members with diabetes were slightly less likely to get the recommended HbA1c tests and substantially less likely to be maintaining good control over blood sugar levels.

Participating commercial plans reported that 56.7% of patients hospitalized for mental illness saw outpatient providers within 7 days of discharge, up from 55.8% in 2005.

At participating Medicare Advantage plans, only 36.5% of patients hospitalized for mental illness saw an outpatient provider within 7 days of discharge, down from 59.3% in 2005.

In some cases, apparent decreases in quality may be the result of the increasing popularity of the NCQA quality survey program.

Plans that do not participate in the survey program tend to do worse on survey measures than participating plans, and plans that are new to the survey program tend to do worse than plans that have participating for years, officials say.

The full text of the health plan quality assessment is available


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