Some costly health plans fall short on quality

November 5, 2010

High-spending health plans don't always deliver the best care, according to an NCQA report.

High-spending health plans don't always deliver the best care, according to a report issued last month by the National Committee for Quality Assurance (NCQA), a nonprofit healthcare policy group in Washington, D.C.

NCQA bases its findings on health plans' relative resource use (RRU), which shows how the plans use healthcare resources (such as physician visits and hospital stays), for 5 conditions: asthma, cardiovascular conditions, chronic obstructive pulmonary disease, diabetes, and hypertension compared with other plans in the same region serving similar members.

Quality is measured on NCQA's "Effectiveness of Care" requirements, which includes dozens of screenings, maintenance, and risk assessment measures based on age and condition. The RRU analysis shows that many plans that deliver below-average quality use above-average levels of resources.