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In light of the recent NCQA report, plans should consider adopting emerging collaborative models
Eliminating the weak links in delivery of evidence-based care by bringing them up to the level of the top performers could save as many as 88,000 lives per year, according to NCQA's 2008 State of Healthcare Quality report, released last month. Imagine the combined student body of Penn State and Michigan State-that's 88,000 people.
A record 845 health plans reported their performance measures to NCQA, which is something the industry should be exceptionally proud of. It's an indication of the growing earnestness among plans to achieve quality.
After reviewing specific regional performance data, Pennsylvania plans get together regularly and discuss best practices to improve care for the area's entire population, he says. Although they might be competitors, the plans have a business case for improving care among each other's members as well as their own because members frequently turn over among plans.
Turnover is inevitable, so increasing the pool of healthier members in the local market helps level the playing field and reduces the burden of adverse selection somewhat.
He says there's really no value, competitive or otherwise, in not taking care of all the region's members.
"In our patient-centered medical home pilot, there are six plans that are participating," Dr. Snyder says. "We sit in a room together and try to figure out how to improve the management of patients. That's exciting to me that we're not competing on the quality of care. We're trying to improve the quality of care across all of our patients."
Independence Blue's patient-centered medical-home pilot includes 32 practices, 166 physicians and 220,000 patients. Dr. Snyder believes the model has obvious potential to prove itself through NCQA measures, among other things.
For example, NCQA performance measures for mammograms and diabetic retinal eye exams have leveled off. With a medical-home team collaboration, those measures can improve through the application of patient registries that track care needs, case managers who coordinate services, and electronic medical records that keep primary care in the loop with specialists.
The disconnect between specialists-for example, gynecologists who provide mammograms and ophthalmologists who provide retinal exams-and primary care is often the reason patients fail to complete those screenings or the reason why the measurements are impossible to track.
"Patients are not reminded again and again until they get those tests, and we see those performance trends that initially started up, leveling off at a level that is just not acceptable," Dr. Snyder says.
He says the pilot has already shown improvement on process measures and believes it will prove its cost-effectiveness and outcomes improvement within two or three years.
Julie Miller is editor-in-chief of MANAGED HEALTHCARE EXECUTIVE. She can be reached at firstname.lastname@example.org