Media Release

For: Immediate Release
Date: May 21, 2007

State Report: Little Differentiation Between Insurers in Utilization and Quality Measures
Department of Health and Office of the Health Insurance Commissioner report also reveals RI and New England score better than US quality marks in most instances

Today, the Director of Health and the Health Insurance Commissioner jointly released the eighth annual publication of the Rhode Island Health Plans’ Performance Report .  This Report, based on 2005 submissions to the National Committee for Quality Assurance (NCQA), provides information on 29 separate measures covering 7 dimensions of performance (i.e., enrollment, utilization, prevention, screening, treatment, access, and satisfaction).  Health plan performance is both trended over time and compared to regional and national averages. 

The report reveals little significant variation between the two major commercial insurers in Rhode Island – Blue Cross and Blue Shield of Rhode Island and United Health Care of New England - across most quality measures; an exception was in the health plan satisfaction and complaint measures where Blue Cross outscored United. As in the past, Rhode Island scored below averages for New England and well above US averages in most of these measures.

“Rhode Island and New England’s superior quality performance is probably not due to health plan competition on clinical quality measures, but instead due to our investments in public health, standards of clinical care, and health plan and regulatory support of national HMO accreditation standards,” said Director Health David R. Gifford, MD.

“Health Plans in Rhode Island do not appear to be differentiating based on clinical quality measures,” said Health Insurance Commissioner, Christopher Koller. “This is not too surprising – their physician networks are similar and employers generally don’t purchase health insurance based on quality measures. Where the state has seen improvement over time – as in immunization levels and diabetic eye screening - the driving factor has been public accountability, and collaboration – both across health plans and providers, and with the public sector.”

In the utilization section, the report reveals that Rhode Islanders generally are admitted to hospitals more than their New England neighbors and visit emergency rooms a bit less. In both of these marks, Blue Cross and Blue Shield scored slightly lower than United Health Care of New England. Commercial inpatient hospital utilization declined by 10 percent between 2004 and 2005, at a time when hospitals financial performance was starting to weaken. 

“Rhode Island’s hospitals are facing a complex set of challenges, trying to remain solvent while serving the state and their respective communities. The decreases in utilization reported here shed some light on the difficulties they are facing,” said Dr. Gifford.

On the whole, in 2005, Rhode Island health plans performed better than their national counterparts on 9 of 15 clinical quality measures, and performed not as well on only 1 measure.  For example, RI plans delivered preventive services such as adolescent immunization and smoking cessation advice to a greater percentage of their members than most other health plans nationwide.  Screening rates for colorectal and breast cancers also exceeded the national rates.

However, Rhode Island’s commercial health plan clinical quality scores lag behind the rest of New England in 12 of the 15 measures studied. This, says Koller, points to the continuing need for improvement efforts by the health plans. “Health Plans – in their payments to providers, in their access to data, and in their provider and member interactions – can and should accelerate clinical quality improvement.  When they look at the needs of the populations they serve and design programs and investments to respond to those needs, we would expect the commercial insurers to work and collaborate on similar initiatives. They will continue to use their resources – consistent with their statutory direction in Rhode Island, and national accreditation standards – to produce meaningful clinical improvement.”
“In the long run,” added Dr. Gifford. “We need systems of medical care in which physicians and other health care providers practice according to best medical evidence. Health plans can make that happen”. 

The Office of the Health Insurance Commissioner and the Department of Health together note that public performance reporting is one of the most effective ways to focus healthcare improvement efforts, and a way to hold health plans and providers accountable for the way services are provided.  This information may also guide policy-makers in their efforts to create a more balanced healthcare delivery system promoting prevention and primary care (one item on Governor Donald L. Carcieri’s health policy agenda).

The Report is available on HEALTH’s website at: www.HEALTH.ri.gov