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California HMO Report Tallies Lives Saved Through Regular Checkups

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San Francisco, CA, October 3, 2002 - As the name implies, health maintenance organizations aim to maintain and improve their members' health by encouraging regular checkups and appropriate medical treatment for illnesses. For the first time, the annual HMO quality report of the California Cooperative Healthcare Reporting Initiative (CCHRI) evaluates current and past performance of participating HMOs in terms of improved outcomes and lives saved. For a few chronic health conditions, the 2002 Report on Quality shows how many deaths or other negative outcomes are being prevented as plans improve the quality of medical care received by their members. It also predicts how many more lives can be saved if improved performance is maintained in the years to come.

For example, when comparing 1999 and 2001 rates, the report finds that:

  • An additional 48,000 HMO members with diabetes showed improved levels of cholesterol control, preventing almost 200 deaths or subsequent heart attacks. If they maintain this level of control over the next five years, almost 1,000 deaths or nonfatal heart attacks will be prevented.
  • More than 41,000 members with diabetes achieved improved blood sugar control, preventing more than 200 deaths or nonfatal heart attacks. If the patients maintain this level of control over the next five years, over 1,000 deaths or subsequent heart attacks will be prevented.
  • An additional 5,000 patients recovering from an acute heart problem demonstrated better levels of cholesterol control, preventing about 30 deaths or nonfatal heart attacks. If they maintain control over the next five years, almost 150 deaths or heart attacks will be prevented.

"Americans are healthier today than ever before, and health plans play a major role in this," said Gordon K. Norman, MD, MBA, a member of the CCHRI Executive Committee and vice president for health care quality at PacifiCare, one of the health plans in CCHRI. "With each successive CCHRI report card, we see gradual improvement in health plan performance—and with that sustained improvement, Californians are experiencing very tangible, positive, long-term impacts from our focus on prevention and systematic care management."

On average, California's major HMOs have made important improvements in clinical care in the past three to four years. For example, all four measures for diabetes care for seniors-retinal eye exams, blood sugar tests, kidney disease monitoring and cholesterol level testing-have risen dramatically since 1999 (see attached table). Use of beta blockers after a heart attack has increased notably for both commercial and Medicare populations since 1998, as has cholesterol management after acute cardiovascular events.

"The 2002 report has good news for millions of Californians in HMOs, especially those with chronic illness," said Joel D. Hyatt, MD, a member of the CCHRI Executive Committee and assistant associate medical director for the Southern California (Kaiser) Permanente Medical Group, one of the participating provider groups in CCHRI. "The plans and provider groups continue to improve their efforts to support doctors and patients by providing preventive and other medical services that HMO members should receive."

Not all measures have shown this dramatic progress over the years, and, in fact, certain clinical areas have resisted much improvement. However, California results are similar to national averages and confirm that there is still room for advancement in making sure patients receive the medical care and services they should have.

For example, breast cancer screening (mammography screening) in the Medicare population has increased only two percentage points in California in the past four years (from 75 percent in 1998 to 77 percent in 2001). The national HMO screening rate is only 74 percent, indicating that health plans and physicians must work harder to educate women regarding the benefits of early cancer detection. Likewise, other scores such as appropriate medication for patients with asthma are also low (in the 60 percent range), but the California average is slightly higher than the national HMO average for this measure.

Since 1994 CCHRI has collected and reported performance data on health plans. The collaborative of health plans, provider organizations and health care purchasers publishes the information to help purchasers and consumers select quality plans. Starting last year, the data is used by the state Office of the Patient Advocate as the basis for a public report card on HMOs.

CCHRI uses a standardized set of Health Plan Employer Data and Information Set (HEDIS) measures established by the National Committee for Quality Assurance (NCQA), a nonprofit organization that evaluates and publicly reports on quality of managed care plans in the U.S. More than 50 measures are voluntarily reported by participating plans, ranging from cancer screenings to treatment for depression.

Besides HEDIS measures, the report includes results of a standardized member survey of patients' experience and satisfaction with their HMO. An independent research firm administers the NCQA-approved survey for CCHRI. This year, 60 percent of respondents rated their HMO's overall performance 8, 9 or 10 on a 10-point scale, up from 58 percent last year and the year before.

In addition to clinical measures and patients' experience and satisfaction with their HMO, for the second year the report includes data on medical groups and IPAs based on an annual survey of HMO members' experience while visiting their doctor.

The California Cooperative Healthcare Reporting Initiative is a statewide collaborative of employers, health plans and providers dedicated to providing accurate, standardized and comparable reports on health care performance. CCHRI is managed by the Pacific Business Group on Health, a coalition of large health care purchasers.

Long-Term Improvements in Clinical Measures: Sampling of Average Scores for California HMOs 1998-2001

Data for Calendar Year 1998 1999 2000 2001
Diabetes Care - Medicare
Retinal Exams 56 64 68 75
Blood Sugar Tests -- 76 79 85
Kidney Disease Monitoring -- 44 49 58
Cholesterol Level Test -- 74 80 89
Beta Blockers 1 - Commercial 79 88 -- 91
Beta Blockers - Medicare 89 90 93 96
Cholesterol Management - Commercial 57 64 70 75
Cholesterol Management - Medicare 55 61 70 73

1. After heart attack

Note: Not all measures are reported annually by HMOs. Some are reported every two years.

Source: CCHRI Report on Quality, 1999-2002.

Contact:
Clark Miller
Senior Communications Manager
Pacific Business Group on Health
Telephone: (415) 615–6302
E–mail: This e-mail address is being protected from spambots. You need JavaScript enabled to view it

 
 

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