Health plans getting better, report finds

Published on

The San Diego Union-Tribune

While Congress tries to craft a managed-care patient’s bill of rights,
health plans received acknowledgement yesterday that perhaps they may not be doing so badly, after all.

For the second straight year, the National Committee for Quality
Assurance found that health plans have improved in all key areas of care and service.

The news was tempered, however, by a separate report released yesterday
saying health-care premiums have jumped 11 percent this year, the biggest price spike since 1992, causing many companies to consider pushing more out-of-pocket expenses onto consumers.

In the NCQA’s fifth annual State of Managed Care Quality report, the
managed-care industry was praised for taking significant steps in trying to mend the health-care system.

“For two years in a row, we’ve seen that participating health plans are
getting better. The rest of health care is still a real question mark,”
said Margaret E. O’Kane, president of NCQA. “We’ve got one sector that’s reporting its numbers and we know things have improved.”

The nonprofit organization is the country’s largest accreditor of health
plans. Though accreditation is voluntary, receiving the organization’s
thumbs up is often used as a marketing tool by health plans as an indication of quality. Nearly 75 percent of enrollees in health maintenance organizations belong to NCQA-accredited plans.

In particular, according to the report, health plans have improved
efforts at controlling or preventing diseases. In the 373 plans that presented data to the NCQA, 74 percent of patients received a cholesterol screening in 2000 after a heart attack, up from 69 percent in 1999.

The percentage of patients who received beta blockers after suffering a
heart attack rose by 4.4 percent; breast cancer screening rates rose by 1.1 percent, and patients receiving treatment for high blood pressure rose by 12.5 percent.

The report comes as Congress and the White House negotiate a patient’s
bill of rights after years of consumer complaints about managed care.

Not surprisingly, the industry said the report is proof that it is taking steps to improve its quality of care.

The improvements “come from an increased emphasis on quality that is
coming from consumers but also from employers,” said Walter Zelman, president of the California Association of Health Plans, a trade group.

But others questioned the credibility of the report. Jamie Court,
executive director of the Foundation for Taxpayer and Consumer Rights, said NCQA was created with HMO funding and has established standards that are friendly to managed care.

“Unfortunately, this is the only stamp of approval . . . (but) it’s more
of the industry approving itself,” he said.

Preventive medicine has always been an easy matter for health plans to
tackle because it saves them money, Court said. But where they fall short — and where the NCQA is lax in monitoring — are areas where good medicine and good business practice don’t mix.

Areas such as how many patients doctors in health plans see in a day and
how health plans deal with difficult, expensive medical treatments would be better indicators of the quality of health plans, he said.

In a separate report yesterday, two health-care organizations said
monthly premiums are up sharply, with consumers likely to feel the effects.

“Our old friend, health-care costs, are back in a serious way as a
national issue,” said Drew Altman, president of the Kaiser Family Foundation, which released the report along with the Health Research and Educational Trust.

Kaiser Family is a nonprofit health-care think tank not affiliated with
the health plan Kaiser Permanente. The Health Research and Educational Trust is a health-care research nonprofit. The report was based on a survey of 1,907 responding employers and compared costs from this spring with costs from spring 2000.

The 11 percent increase this year is more than triple the inflation rate, a situation employers blamed on rising prescription drug expenses and general medical costs and a movement by patients away from HMOs to more expensive health plans.

The price spikes will continue next year — several health plans have
announced double-digit premium increases for 2002 — and are expected to
raise costs for workers and increase the number of uninsured. Because of the booming economy and pinched labor market of recent years, employers have been forced to absorb price increases, the authors of the report said.

But faced with additional spikes, 44 percent of employers said they are
“very” or “somewhat likely” to increase the employee-share of health-care costs next year in the form of higher deductibles and co-payments. Other employers may freeze wages to pay for higher premiums, Zelman said.

Additionally, the number of uninsured could increase as more employers,
especially small businesses, are unable to pay the costs and drop coverage.

The report also said enrollment in HMOs has dropped to 23 percent of all
patients this year from 29 percent last year. Membership in less
restrictive but more expensive preferred-provider organizations has increased to 48 percent from 41 percent a year ago.

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