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Community Health Plans Among Best in Nation
Date:10/26/2007

an on a scale of 0 to 10. Within each line of business (Medicare, Medicaid, and commercial) performance on the many individual quality measures are combined into one aggregate score, and health plans are then ranked according to this score.

Providing appropriate care.

Unlike non-coordinated systems, integrated plans can increase the value of the health care dollar by coordinating care in such a way that proper care is provided. The top health plans as rated by the NCQA and the U.S. News and World Report excel at providing an appropriate level of care. Purchasers -- whether public or private; individual or group -- stand to gain considerably by spending their scarce resources on the health plans that can truly add value. Integrated plans, such as the ACHP member plans, are best situated to achieve this goal of added value.

Recent studies indicate that the U.S. health care system does not consistently provide high quality care to patients. In many cases, patients do not receive the appropriate level of care. Poor quality care leads to as many as 45 million avoidable sick days, according to the NCQA. According to one study, adults receive recommended care only slightly more than half the time, and receive recommended care for diabetes only one-quarter of the time. Further, a recent study published in the New England Journal of Medicine states that children receive proper outpatient care less than half the time, and receive the proper preventive care only 41 percent of the time.

Comparing quality of care in different settings.

Unfortunately, reliable quality data are not available for the approximately 100 million commercial enrollees in preferred provider organizations (PPOs) that did not reported HEDIS(R) data in 2007, according to the NCQA. According to the Kaiser Family Foundation, more than 60 percent of employees are covered by PPOs. Thus, the majority of workers in the U.S. presumably cannot choose a health plan whose quality an
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SOURCE Alliance of Community Health Plans
Copyright©2007 PR Newswire.
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