NCQA Report: Quality, Spending Not Linked; Autism Fears Suspected As Children's Vaccinations Decrease in Private Plans

WASHINGTON, D.C. — The new State of Health Care Quality report from the National Committee for Quality Assurance (NCQA) has two new findings about the nation’s health care:

  • Health plans that spend the most on care don’t always deliver the best quality
  • Vaccination rates have dropped for kids in private plans, while rates continue to rise for Medicaid children

The State of Health Care Quality is NCQA’s annual analysis of the overall quality of American health care.

Relative Resource Use (RRU): Insight into Value
News that high-spending health plans don’t always deliver the best care comes from findings on relative resource use (RRU) – documented for the first time in the report across five common, costly and chronic diseases.

RRU indicates how intensively health plans use health care resources (such as physician visits and hospital stays), compared with other plans in the same region, serving similar members. When used alongside quality measures, RRU makes it possible to talk about quality and cost simultaneously.
Given the definition of value as the intersection of health plans’ spending (resource use) and their results, RRU reveals the value that plans offer.

RRU analysis shows that many plans that deliver below-average quality use above-average levels of resources. More care is not always linked to better results, confirming that the saying “you get what you pay for” does not apply to health care.

New Trends in Use of Vaccines
Childhood vaccination rates in 2009 declined by almost four percentage points in commercial plans.
  
A possible cause of this drop is commercial plan parents may refuse vaccines for their children based on the unproven, but increasingly popular, notion that vaccines cause autism. Celebrity activists are outspoken advocates of this view. Interestingly, we see vaccination rates in Medicaid – the program serving the poor – continuing to steadily improve.   

“The drop in childhood vaccinations is disturbing because parents are rejecting valuable treatment based on misinformation,” said NCQA President Margaret E. O’Kane. “All of us in health care need to work together to get better information to the public.”

The State of Health Care Quality Report examined quality data from over 1,000 health plans that collectively cover 118 million Americans.

About the National Committee for Quality Assurance

Celebrating its 20th anniversary in 2010, NCQA is a private, nonprofit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care. NCQA is committed to providing health care quality information for consumers, purchasers, health care providers, and researchers.

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Media Contacts

Andy Reynolds
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Apoorva Stull
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