Comparison to National Achievement on Comprehensive Diabetes Measures of the National Committee on Quality Assurance (NCQA)*, 2007

Table 2 and Figures 8-12 compare Greater Cleveland’s region-wide results on NCQA’s “Comprehensive Diabetes Measures” with the achievement of health plans reporting their results to NCQA in 2006. Most health plans nationwide voluntarily report their information to NCQA to create a Healthcare Effectiveness Data and Information Set (HEDIS), a tool used to measure achievement on important dimensions of care and service. Better Health Greater Cleveland is fortunate to have health plan partners who are members and active participants in our Leadership Team and Clinical Advisory Committee. With their encouragement, we have defined our data collection and reporting capabilities to be able to report our results in a way that is consistent with alternative approaches and standards.

The table and figures that follow compare our practice partners’ results with health plans nationwide, using their 2006 data as reported by NCQA in 2007. The 9 standards in NCQA’s Comprehensive Diabetes Measures include some that are included in Better Health’s standards, such as the performance of an eye examination (Figure 10, left panel) and obtaining at least one Hemoglobin A1c in the one-year measurement period (Figure 8), but they also include standards that are slightly different from those we have chosen (such as the negatively framed “poor glycemic control” standard, discussed in Part One, Section D.2. and shown in Figure 9, right panel).

Included in the Better Health Greater Cleveland reports for these figures are 23,461 patients of the 30 partner practices at Cleveland Clinic, Kaiser Permanente, and The MetroHealth System, stratified by insurance, as reported above and in the NCQA’s “State of Health Care Quality” report (available at www.ncqa.org, see pp. 35-37). In addition, we provide information in Table 2 and Figures 8-12 to enable comparison of Better Health’s results among the uninsured with health plan data across insurance categories.

There are several common findings across these comparisons:

First, as displayed best in Table 2, among health plans reporting to NCQA, there are consistent and fairly substantial differences in achievement across insurance categories, with Medicare plans reporting the highest levels and Medicaid plans performing much less well.

Second, Greater Cleveland’s achievement is better than the national health plan average across all standards and all insurance types.

Third, for several standards (for example, see Figures 8 and 9,) Greater Cleveland’s Medicaid achievement is substantially higher than the national average for patients in Medicaid health plans.

Fourth, there are no NCQA data pertaining to the uninsured. In the U.S., there are more than 47 million uninsured. They are largely invisible in performance reporting.

Finally, Greater Cleveland’s uninsured diabetic patients compare quite favorably to the national average of performance for insured groups.

Table 2. NCQA / HEDIS Comprehensive Diabetes Care Measures. Better Health’s Region-Wide Achievement Compared to Health Plans Nationwide.

*Monitoring Nephropathy / Kidney Management (urine microalbumin screen or ACE‐inhibitor or ARB prescription)
**Regional achievement describes the 30 EMR practices (Cleveland Clinic, Kaiser Permanente and MetroHealth.)

Figure 8. Regional Achievement Compared with Nationwide Health Plan Data: Hemoglobin A1c Testing Performed

Figure 9. Regional Achievement Compared with Nationwide Health Plan Data: Good Hemoglobin A1c Control (A1c < 7) (Left Panel) and Poor Hemoglobin A1c Control (A1c > 9) (Right Panel)

Figure 10. Regional Achievement Compared with Nationwide Health Plan Data: Eye Examination Performed (Left Panel) and Monitoring Nephropathy / Kidney Management* (Right Panel) *Urine microalbumin obtained or ACE inhibitor or ARB prescription

Figure 11. Regional Achievement Compared with Nationwide Health Plan Data: LDL Cholesterol Screening (Left Panel) and Good LDL Cholesterol Control (LDL < 100) (Right Panel)

Figure 12. Regional Achievement Compared with Nationwide Health Plan Data: Very Good Blood Pressure Control (BP < 130/80) (Left Panel) and Good Blood Pressure Control (BP < 140/90) (Right Panel)