Brian Schilling, director of communications for NCQA, pointed out that the Veterans Health Administration is a model plan in terms of quality of care, while six Boston-based health plans, which are all in the top 10 national HEDIS Effectiveness of Care Measures, collaborate on quality of care issues.
Besides sharing a concentrated healthcare infrastructure and being early IT adopters, Blue Cross and Blue Shield of Massachusetts, Fallon Community Health Plan, Harvard Pilgrim Health Care of New England, Harvard Pilgrim Health Care, Health New England and Tufts Associated Health Maintenance Organization/Tufts Health Plan often work together to improve clinical quality.
The Veterans Health Administration, the nation's largest healthcare system, which has converted 100 percent of its records to electronic format, is being recognized as the model for health plans to emulate.
"They beat the national standards and provide top quality of care amidst ballooning costs and cutbacks," Schilling said. "They are doing a great job."
Among key quality measures, data on controlling high blood pressure, cholesterol management and cholesterol of patients with diabetes improved by 4 percent.
Overall, 41 out of 43 quality measures improved. The results of the remaining two measures were statistically insignificant.
IT upgrading, better reporting and decision-support tools, intensive disease management and care management programs, patient and provider education, compensation strategies, pay-for-performance plans and preventive strategies have all contributed to the improvements.
Schilling noted that two areas could greatly impact quality of care if health plans and providers adopt them.
Approximately 80 different pay-for-performance projects are being managed nationwide. "Pay-for-performance has the huge potential to rewrite quality of care," said Schilling.
"We're also seeing a lot of IT progress," he said. "Having a full-fledged EMR system is complex and expensive. Right now, although there isn't a business case for provider practices to heavily invest in IT, retraining and education, the situation is getting better."
Still, implementing IT systems and providing IT system support are critical in attaining the Holy Grail of having a national EHR system in place. Schilling said that even a bare bones attempt, such as providing an electronic patient registry, would make a huge difference in quality of care.