Sunday, October 5, 2008

Observations on the Leveling Off and Narrowing Confidence Intervals in the NCQA State of Health Care Quality Report

The NCQA has released its annual ‘State of Healthcare Quality’ report that examines the quality performance of the nation’s participating health insurers. While the NCQA says the big news is that the NCQA is relevant, variation persists, the NCQA is relevant, that many measures are incrementally if slowly getting better, the NCQA is relevant and that Federal programs need to get aboard comparative quality bus, the Disease Management Care Blog was much more interested in the actual numbers and their trends.

Speaking to the currently limits of medicine and biology, less than two thirds of persons with high blood pressure achieve control of their condition, just more than half of persons who have had a heart attack attain low cholesterol levels and about 80% of kids get adequately immunized.
But more importantly, the pace of improvement in many measures – while still showing gratifying increases – is leveling off. For example, check out these trends snipped from the NCQA report on A1c testing among persons with diabetes:

and blood pressure control among persons with hypertension:

Also note that the confidence intervals are narrowing, meaning the spread between competing health insurers is narrowing. This may be a function of increasing numbers of participating insurers or less variation. Either way, the DMCB predicts that with time those point scores are going to cluster even more tightly.

The good news is that if these trends continue, variation will diminish. The bad news is that the insurers will become indistinguishable from each other and have to locally compete on tenths of a percent of improvement. Will this force them to look for ‘breakthrough’ strategies for improvement or will they settle with the conclusion that usual care is reaching the limits of improvement that can be attained in usual settings relying on usual ways of payment?

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