Friday, November 17, 2006

Medicare Private Drug Plans Fail to Offer Accurate Information to Consumers, New Report

Compare and find affordable health insurance plans.

Sacramento, California
October 16, 2006

Report Finds Medicare Private Drug Plans Fail to Offer Accurate Information to Consumers - Consumer Groups call for dramatic reform before 2007 Part D enrollment opens on November 15

With the next enrollment period for the Medicare Part D prescription drug benefit looming, California Health Advocates and the Medicare Rights Center are demanding that the Centers for Medicare & Medicaid Services (CMS) require Medicare private drug plans to provide timely and accurate information to people with Medicare who turn to the plans’ call centers for assistance. According to a new report issued today by the two consumer organizations, call center representatives for companies offering Part D coverage remain unable to answer basic consumer questions regarding how the benefit works.

The report found that the call centers frequently could not provide the information people with Medicare needed to make appropriate enrollment decisions. In “Getting the Runaround: Problems with Obtaining Accurate Information from Part D Plans,” the two advocacy groups state that plan call centers are expected to serve as a crucial link to information about Part D coverage, but “independent surveys and anecdotal reports from counselors show serious lapses in the ability of Part D plans to provide accurate and timely information and to successfully guide people with Medicare seeking to access the benefit.”

“Good advice is the only antidote to the convoluted prescription drug benefit that older and disabled Americans are forced to navigate,” said Robert M. Hayes, President of the Medicare Rights Center. “Too often a call to one of the private drug plans does more to mislead, than to help.”
According to the report, CMS has failed to set adequate standards for the accuracy of information given by call centers.

In preparation for the next enrollment period, the report recommends that CMS provide detailed requirements for the information customer service representatives (CSRs) must be able to provide, and take action to ensure those requirements are being met. “The level of frustration expressed by people contacting our office is acute,” remarked Clare Smith, President/CEO of California Health Advocates, “The plans must be required to put resources into the provision of responsive and reliable service to those seeking access to prescription drug benefits.”

The report recommends that CMS ensure that the training and scripts provided to call center operators enables them to provide information about the following:

Enrollment process

How the specific plan works, including explanations of the coverage gap and important information for people eligible for the low-income subsidy

Plan formulary, including which drugs are covered and specifics on any coverage restrictions and limitations

The report also recommends strengthening Medicare private drug plans’ capacity to communicate with non- and limited-English speakers and designating staff as experts in specific subject matter, such as enrollment, premium/cost-sharing, and coverage appeals.

Thursday, November 16, 2006

National Committee for Quality Assurance Reports on Gaps in Health Care Quality

September 27, 2006

New report calls for expanding accountability for 100 million who do not benefit

More than 70 million Americans enrolled in private health plans saw the quality of their health care improve in 2005, according to a new report by the National Committee for Quality Assurance (NCQA). One in four Americans are enrolled in that collect and report data on the quality of care.

Among private commercial plans, 2005 marked significant improvements in childhood and adolescent immunizations.

People enrolled in Medicare health plans saw important gains in smoking cessation while those in Medicaid plans benefited from a sharp increase in childhood immunizations. “All of us have a stake—collectively and individually—in safeguarding our nation’s health,” said NCQA President Margaret E. O’Kane. “The past decade has demonstrated the benefits of measurement, reporting and accountability, but three out of four people don’t enjoy those benefits today. It’s time to ask, ‘Why not?’” The report documents the tremendous gains in health care quality achieved over the past decade that NCQA has been reporting on health care quality. Among them:

Children in commercial health plans are nearly three times more likely to receive all recommended immunizations than eight years ago;

Diabetics are more than twice as likely to have their cholesterol controlled to recommended levels as in 1998; and

More than 96 percent of patients who suffered a heart attack were prescribed beta-blockers to help prevent a second, often fatal, heart attack, up from 62 percent in 1996—saving between 4,200 and 5,300 lives over the past decade.

While most aspects of care improved in 2005, the quality of care for Americans with mental health problems remains as poor today as it was a decade ago.

New approaches must be developed to bring mental health care quality to the level of clinical effectiveness that evidence shows is possible.
100 Million Americans ‘Left Behind’ - The report also highlights the fact that Americans in health maintenance organizations (HMOs) and point of service (POS) plans are significantly more likely to benefit from quality measurement than those in other plans.

More than 73 percent of such plans submitted performance data in 2005—the highest proportion in history. But enrollment in such plans has declined to 33 percent today.

Most Americans – more than 6 in 10 – are now in preferred provider organizations (PPOs) and consumer directed health plans (CDHPs). The overwhelming majority of those plans do not collect and report data on the quality of their care. In 2005 NCQA asked PPOs to voluntarily report their performance using HEDIS® measures; a total of 80 commercial PPOs did so in 2005. This has helped to reverse a three-year decline in the number of Americans in accountable health plans: 12 million more Americans are now in accountable plans than last year.

This holds promise for dramatic improvements in care and quality of life for millions. But more than 100 million insured Americans still do not enjoy the improved care that results from quality reporting. “Working families deserve accurate and relevant information about the quality of their health plans, doctors and hospitals. The PPOs that have stepped up to the plate deserve applause, but there is much more work to be done,” said Ann Kempski, Director of Health Systems Policy at Service Employees International Union.

“Health care is concern number one for families, and they deserve a high quality health plan that makes such information available. Quality improvement will accelerate if workers use tools such as those developed by NCQA to choose an affordable, high-quality plan that meets their families’ needs.”

Quality Gaps Remain - Despite the reported gains, enormous differences persist between the performance of the health care system as a whole and the top accountable health plans. NCQA estimates that if the entire health care system performed at the level of the top plans, between 37,600 and 81,000 lives would be saved each year.

These quality gaps also lead to over $10 billion in lost productivity and almost 65 million avoidable sick days. “The health of our workforce is a precious asset,” said Mary Bradley, Director of Healthcare Planning at Pitney Bowes. “Measuring and improving quality healthcare for our employees is a core corporate value at Pitney Bowes.”

New strategies needed to maintain improvements - After seven consecutive years of quality improvements there are signs that the pace of improvement may be slowing: fewer measures showed statistically significant year-over-year gains than in 2004.

This may indicate that in some cases, there is less room for improvement. NCQA is pursuing new strategies to achieve continued gains. One key to further improvement is increasing the number of accountable health plans that report quality data.

NCQA is working with consumers, employers and health plans to expand the number of accountable PPOs and CDHPs. That effort will receive a significant boost in 2007: The Centers for Medicare & Medicaid Services (CMS) has required PPOs participating in the Medicare Advantage program to report HEDIS measures for public reporting in 2007.

In addition, the Office of Personnel Management (OPM) has required PPOs and other fee-for-service plans serving 9 million federal employees to report five HEDIS measures in 2007 for public release in 2008. In August, President Bush recently signed an Executive Order directing federal agencies sponsoring or administering health plans to provide information on cost and quality to beneficiaries.

“President Bush has urged greater accountability and transparency in health care in the public and private sectors,” said Thomas Barker, Counselor to the Secretary of the United States Department of Health and Human Services.

“People have a right to know the price and quality of their health care. By providing information about cost and quality, we can meet the needs of all Americans.” The State of Health Care Quality 2006 may be downloaded at no cost from NCQA’s Web site,

For each measure of clinical quality, the report includes complete year-over-year performance data and highlights the top-performing state. Print versions can be purchased by calling (888) 275-7585. NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations, recognizes physicians and physician groups in key clinical areas and manages the evolution of HEDIS, the tool the nation’s health plans use to measure and report on their performance.

NCQA is committed to providing health care quality information through the Web, media and data licensing agreements in order to help consumers, employers and others make more informed health care choices.