Tuesday, October 9, 2007

Health Insurance - Odds 1 in 3 Yours Isn't Doing Everything to Keep You Well

One hundred million insured or one in three Americans have no idea if their health insurance plan is doing everything to keep them healthy. This ignorance could cost them their lives. This is the conclusion from the recently released 2007 State of Health Care Quality report by the National Committee for Quality Assurance, a non-profit organization which for over a decade has accredited health insurance plans for their performance. NCQA rates health plans on their ability to provide their enrollees with basic and proven preventive treatments, controlling high blood pressure, diabetes, cholesterol, among many others, consistently and routinely. While the industry has made significant improvements, much more needs to be done to save lives.

When NCQA started reviewing the quality of care delivered, it found that in 1996, on average only 62% of heart attack patients were getting beta blocker medications. These medications have been proven to decrease the risk of future heart attacks and prescribing them to these patients has been the standard teaching in medical schools for years. Over the past decade on average 98% of the time heart attack patients in health plans accredited by NCQA receive this treatment.

Unfortunately, health plans that didn't submit information for review did less well with 94% of patients getting the prescribed medication. Although it most situations this would be good enough, each drop in percentage translates into lives that could have been saved with a simple proven intervention.

Because this and many other effective preventive treatments weren't done to the level recommended by expert committees, 75,000 insured Americans died prematurely. Had these individuals accessed high performing health plans they would be alive today. If the entire industry performed as well as the top plans, $3.7 billion spent on hospital costs would have been avoided. Preventive care saves lives and money when done consistently and regularly. The problem is that within the healthcare system this is far from the case.

Part of the problem is that the most popular insurance plan, the PPO plan, does not have the same level of scrutiny when it comes to performance or accountability like a HMO plan. Until last year, no PPO plans provided NCQA any information on how well they did to keep you well. This year, those plans that cover one hundred million Americans still have not committed to submitting information for review. This lack of transparency has California's insurance commissioner developing a report card rating PPOs, much like the current system which lists HMOs, available to consumers by 2009. Until then, you have a one in three chance that you are in a plan that answers to no one and that the care you receive is not ideal.

Fortunately you aren't powerless. With open enrollment, now is a good time to see if your choices whether HMO or PPO include a NCQA accredited program by going to www.ncqa.org. If not, ask your human resources department to consider one for next year. Take the same amount of time and diligence you would do researching for your next car. It's your money. Don't you deserve the best care possible? With buying a car, if you purchase a lemon, you always have another chance to get another one. With your health, the stakes are higher. Choose wisely. The information is available. Act on it. Next year tens of thousands won't be around to rectify their mistake. Make sure it isn't you.

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