There are some things about health care that will never change, nor should they. At its heart, health care remains one of the most personal of professional endeavors, a human interaction that requires a delicate blend of science, intuition, and compassion.
But surrounding the core skills required in every encounter between physician and patient, is a system that supports – or is supposed to support – that interaction. In today’s world, often a doctor can only be as good as the system that surrounds him or her. That “support system” stretches beyond the confines of the health care delivery system itself and includes insurers, purchasers, and even patients, all of whom play a role in promoting high quality care.
Over the past 15 years, the National Committee for Quality Assurance (NCQA) has learned a great deal about the quality of our nation’s health plans, hospitals and medical groups. Much of our work has focused on publicly reporting performance data on health plans, physicians, and many other levels of the health system as a way to create accountability and promote continuous quality improvement.
The good news is that health care quality for many Americans is improving. As reported in NCQA’s 2005 State of Health Care Quality report, performance is up on 40 of 43 clinical measures, which means that more people with diabetes are getting appropriate screenings and controlling their blood sugar. It means that more people with hypertension are successfully managing their blood pressure. More than 40,000 lives have been saved over the past eight years due to these and other improvements.
The problem is that quality gaps still remain in the system. These quality gaps represent an estimated 39,000 – 83,000 deaths each year due to conditions like diabetes and heart disease, where we know how to care for patients. These quality gaps also represent between $2.8 billion and $4.2 billion in avoidable medical costs and up to 83.1 million sick days each year. In addition, rising costs are leading employers to shift workers into new types of health plans that do not yet measure and report on quality. Enrollment in the types of plans that tend to report on their performance (HMO and Point-of-service plans) actually declined from 2003 to 2004, while enrollment increased in plans that do not report their results. This shift in enrollment means that patients have less and less information to guide their health care decisions. It may also mean that in the future there will be less of an incentive for health plans to improve the care they deliver.
Perhaps the most useful conclusion that NCQA can draw from over 15 years of working to improve our health care system, is that regular measurement and public reporting drive improvement. Our challenge now is to apply this lesson broadly: to have measurement and accountability hardwired into the systems of every doctor’s office, every hospital and every health plan in the nation. Nothing else we can do will have a more profound or positive impact on health care quality.
The importance of effective partnerships in the pursuit of improved quality cannot be overstated, especially as the focus of quality measurement and reporting pushes down to the delivery system level. NCQA relies on the support of its sponsors to aid in its commitments to develop and implement important strategies and programs. By supporting NCQA and its work, you can not only become a catalyst for change, but also a leader in the movement to help create higher quality and accountability in health care throughout the United States.