Managing health care costs and achieving a high quality health system aren’t parallel goals – they’re inter-related and two sides of one coin. Adding more enrollees to existing poorly integrated health delivery organizations will simply increase costs while delivering sub-optimal outcomes to patients.

In its 13th annual report card on the U.S. health system, the National Committee for Quality Assurance (NCQA)’s The State of Health Care Quality 2009 adds more statistical evidence to the argument for health reform in America. 2009 has seen “meager progress” according to the President of NCQA, Margaret O’Kane. In her introduction to the report, O’Kane argues for five key elements in health reform that will directly improve quality:

1. Hold all health plans accountable, through accreditation, data reporting of HEDIS and CAHPS measures, and demonstrating quality improvement.

2. Reform payment and delivery systems, by paying for performance.

3. Create a framework for quality measurement, setting priorities for measurement, and aligning public and private markets by using similar measures for comparison.

4. Focus on Medicare and Medicaid quality, which NCQA has found slipping in the past 3 years.

The report analyzes quality of care data for 116 million Americans enrolled in health plans.
NCQA found that there is high variability in quality of care for a broad range of conditions. A key example is diabetes, which has reached epidemic proportions in the U.S. When well-managed,
diabetics can gain five or more years of life. NCQA found that the highest quality of care for diabetics is achieved in New England; the lowest, in the South Central region including Alabama, Arkansas, Kentucky, Louisiana, Mississippi, Oklahoma, Tennessee, and Texas).

There is some good news in the report:

  • Improvement in the use of beta-blockers administered to Medicare patients who had a heart attack within the previous 6 months.

  • Near universal high-quality care for Americans with asthma.

  • Gains in helping Medicaid beneficiaries to stop smoking (important because 1 in 3 Medicaid beneficiaries smokes).
The back of the report contains a plethora of quality measures on health conditions and lifestyle behaviors that provide the backstory to NCQA’s conclusions and recommendations. One of the best parts of this report is the 13-page appendix containing a long list of reference articles on health care quality, organized by theme. This will be useful for anyone looking for vetted evidence on various aspects of health quality.

Health Populi’s Hot Points: If all health plans performed at the 90th percentile level demonstrated by the top 10% of plans in the U.S., between 49,400 adn 115,300 deaths could be prevented every year in the U.S. Furthermore, billions of dollars would be saved in the U.S. health system that could be deployed elsewhere — say, to cover the uninsured in better-performing plans.

“The status quo is dangerous and costly,” NCQA concludes. NCQA data prove that by spending more, you don’t get more. We learned this from Shannon Brownlee’s important book, Overtreated, we’ve learned it from the Dartmouth Health Atlas, and now we have the 13th annual NCQA State of Health Care Quality report to further bolster that fact.

We must reform payment to reform clinical workflow and nudge all players to do right by patients. Paying wrong can kill in health care.