National Business Coalition on Health issued yesterday its annual findings that evaluate the quality and efficiency of U.S. health plans.

"To truly reform the U.S. health care system requires a triple aim approach: improve health, improve health care and lower costs,” says Andrew Webber, president and CEO, NBCH. "To accomplish this it’s critical to have a strong interaction between the health care purchasers and their health plans," he adds.

The survey collected heath care data from 64 health plans representing more than 100 million Americans. The plans in the survey submitted responses and documentation on their performance to NBCH through its eValue8, which is a tool the group created to help employers compare and benchmark health plans services.

The judges evaluated the plans based on consumer engagement, physician performance, pharmaceutical management, prevention and health promotion, behavioral health and disease management and member identification.

The survey report highlights the top performing plans for each category, but five plans (HMO and PPO) stood out across the various categories:

  • CIGNA New York
  • HealthPartners Minnesota
  • Kaiser Permanente Northern California
  • Kaiser Permanente Northwest
  • Kaiser Permanente Southern California

Other key findings from the survey include:

  • By identifying gaps in care, the research shows plans need to improve their performance with monitoring whether members are taking their medication as prescribed. For example 33% of plans report having optimal plan monitoring of depression medication adherence.
  • Yet only five percent of plans report optimal plan monitoring of substance abuse medication adherence, while 49% indicate optimal monitoring of diabetes and coronary artery disease medication adherence.
  • The findings also reveal that plans are offering higher monetary rewards to doctors for higher quality care. Nearly 70% of plans indicate administering incentives to physicians for better performance, while 58% provide financial incentives that are based on either clinical process or outcome measures.
  • Identification rates for chronic conditions were low – on average plans have identified only two percent of members as obese and 0.5% as tobacco users. This can be due in part to low personal health assessment completions, averaging only three percent.
  • Participation rates for various behavioral health disease management programs were reported at or below five percent of estimated prevalence for alcohol problems and less than 20% for estimated depression prevalence.

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