News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

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News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel
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U.S. Health Improves as Outcomes Measurement and Pay-for-Performance Efforts Bear Fruit

When the NCQA reported significant improvements in healthcare last September, an Associated Press article on this topic was picked up by Yahoo News, CBS, Fox and many other news sources across the country. It was likely so widely reprinted because it was a rare piece of good news: The quality of the health care provided to millions of Americans improved last year across several dozen categories!

It is first evidence that efforts to improve patient safety and encourage providers to follow recommended health guidelines have made a difference. The laboratory industry has been front and center in this trend. For example, early in this decade payers began asking laboratories to report Health Plan Employer Data and Information Set or HEDIS-required measures such as Pap testing, Pap results, HbA1c testing, HbA1c results, among others. Improved use of laboratory testing as a result of HEDIS requirements has contributed to improved outcomes in several areas of the American healthcare system.

NCQA stated that, for patients covered by private insurance plans, there were significant improvements in 36 of 42 categories measured by HEDIS data sets. Improvements were noted in immunization rates among insured children, cervical cancer screening, colorectal cancer screening, and the controlling of high blood pressure in hypertension patients. While each of these areas may have only improved by a few percentage points last year, over a 10-year period, improvements are highly visible. For example, last year 96% of heart attack patients were given drugs to lower their blood pressure and slow heart rate to prevent a second attack. A decade ago, only 62% of patients suffering heart attacks were given those medications.

According to Margaret E. O’Kane, the president of the National Committee for Quality Assurance, “This past decade has demonstrated the benefits of measurement, reporting, and accountability, but three out of four people don’t enjoy those benefits today.” In fact, only 1 in 4 Americans are enrolled in a health plan that collects and reports data on the quality of care. O’Kane urges us to start asking why.

As Dark Daily reported in recent months, pay-for-performance programs are being instituted by the Medicare program and insurance companies across the US. The time is fast approaching when these programs and quality of care measurements for physicians, hospitals, and laboratories will become the norm. As the media gives greater exposure to the benefits of measuring quality of care, laboratories can be certain that they will see increased accountability and reporting on their quality by insurance companies.

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