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High spending on care doesn't always deliver quality

October 15, 2010 | By
Tools

Health plans that spend the most on care don’t always deliver the best quality, concludes a new report from the National Committee for Quality Assurance (NCQA).

Insurers said they spend most on five costly, common chronic illnesses--asthma, cardiovascular disease, chronic obstructive pulmonary disease, diabetes and hypertension. However, there was a high degree of variation among plans and no clear correlation between resource use and quality. High-quality care for diabetics, for instance, can be delivered at either high or low levels of resource use, according to NCQA.

More use of healthcare resources, such as inpatient bed days or procedures, can actually be associated with poorer quality, Greg Pawlson, NCQA executive vice president of research, told CNN Money. "Areas in the country where health plans allow for greater use of healthcare resources don't always deliver better quality of care compared to other areas where the use of resources is less," he said.

To improve quality, health plans should focus on creating more incentives that encourage and reward healthcare professionals for raising the bar on quality, Cigna Chief Medical Officer Dr. Jeffrey Kang told Trading Markets. Kang said education and awareness programs that reach and remind people about the importance of getting preventive screenings or complying with their doctor's treatment plan have been, and will continue to be, essential to improving quality. As one example, Cigna will remind approximately 600,000 people this year to get a colorectal cancer screening.

The value of insurers providing recommended, quality care is about $451 per person per year, according to a mathematical model Cigna developed. Based on 2009 data, Cigna found the total savings attributable to using evidence-based standards of care is approximately $197 in direct medical costs and $254 in indirect productivity savings per person per year, according to Trading Markets.

To learn more:
- read the Trading Markets article
- check out the CNN Money story
- read NCQA’s report analysis
- view the full NCQA report 

Related Articles:
U.S. healthcare spending drops for first time ever
Hospital quality of care improves, but weak spots persist
AHRQ releases new healthcare quality data categorized by payer
Rising health costs: The effect of a 'more-is-better' attitude

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