In This Issue:
President's Perspective: ACCORD and ADVANCE Findings Highlight the
Need to
Study Comorbidities
Recently, the National Heart, Lung and Blood Institute (NHLBI) announced that it would halt
a
section of a large study known as ACCORD that looked at control of hemoglobin A1c in high-risk
patients with diabetes. The researchers found that patients whose A1c levels were controlled very aggressively experienced excess mortality compared
with a group with higher A1c targets. Accordingly, NHLBI halted the intensive-therapy arm of the study.
But just days later, a different group of researchers released
interim data that appeared to contradict the ACCORD findings. A trial conducted by researchers in Australia and elsewhere, the ADVANCE trial,
showed no excess mortality among high-risk
patients whose A1c was aggressively controlled.
The apparent discrepancy between these two large studies has understandably prompted
debate about what constitutes appropriate A1c control targets.
In the past month, NCQA has engaged in several discussions about these
results--and for good reason. Last year, we introduced a new HEDIS measure that assesses the percentage of patients whose A1c is managed to
below 7 percent, a level only slightly higher than the targets of the ACCORD and ADVANCE trials. New evidence demands a new examination of this
measure.
While NCQA will continue to collect data on this measure, in light of these findings
we will take a closer look at all the evidence surrounding measures of aggressive A1c control. We are convening an expert
panel to do just that and will take action as the evidence warrants
once their findings are complete.
Each of these studies looked at patients with diabetes who were also at high risk for
heart disease. Randomized controlled trials are generally performed on younger adults with a single condition and then generalized to the elderly,
children or patients with multiple conditions. As these two studies strongly suggest, it's not that simple. Taking
comorbidities into account leads to more variables in a study. This, in turn, may lead to instances such as the apparent dissonance between the
ACCORD and ADVANCE results, where we may not be able to draw conclusions until the final results are made available and we can cull through
differences in methodology.
These two studies highlight a pressing need to develop the body of medical evidence
surrounding care for patients with comorbidities. 1 in 5 Americans live with multiple chronic conditions; almost one in four Medicare beneficiaries
live with a staggering five or more chronic conditions. We owe it to all of them to meet the steep challenge presented by sorting the
complications that arise from looking at comorbidities. It's the only way that evidence to guide care for these patients will be brought to
par with the evidence for treating their constituent conditions.
NCQA's 2008 Health Quality
Awards Dinner Honors Health Care Leaders
On April 1, 2008, NCQA will host the
2008 Health Quality Awards dinner at the Andrew W. Mellon Auditorium by the National Mall in Washington. NCQA will honor four
remarkable individuals for their singular leadership in improving the quality, affordability and accessibility to health care in the United States.
This year's Health Quality Award honorees are:
Senator Edward M. Kennedy (D-Mass.) Senator Kennedy is a longtime advocate for improved health care and universal health insurance. He is the author of numerous
landmark health care laws, including the HMO Act of 1973, the Community Health Center program, the Health Insurance Portability and
Accountability Act (HIPAA), and the State Children's Health Insurance Program (SCHIP).
Governor Arnold Schwarzenegger (R-Ca.). California's 38th Governor, Schwarzenegger has proposed a five-part reform plan
that would guarantee all Californians can buy insurance, require everyone to be insured, increase Medicaid payments to doctors and hospitals,
promote
balanced financing for health care, and reward healthy choices while containing costs through an emphasis on prevention and better care for people
with chronic conditions.
County Executive Ron Sims. Sims, Executive of King County in Washington
State, has been tackling health care reform with innovative approaches that are becoming national models. Executive Simms led early efforts to
control county employee benefit costs, producing dramatic results in just one year. He chairs the Puget Sound Health Alliance, where the region's
top
corporations, health care providers and governments are working together to control costs while increasing the quality of health
care.
Arkansas Surgeon General Joseph W. Thompson, M.D., MPH. Dr. Thompson is one
of the nation's leading experts and advocates for reducing tobacco use and combating obesity in children. He was the lead architect of the
Tobacco Settlement Act of 2000 and established the Arkansas Health Insurance Roundtable. Under his leadership, ACHI has documented the state's
success in halting progress of the childhood obesity epidemic and helped pass the Clean Indoor Air Act of 2006.
This year, NCQA is also honored to have Mara Liasson, National Political
Correspondent for National Public Radio (NPR), serve as the Master of Ceremonies. At NPR, Ms. Liasson is known for providing key coverage of the past
four presidential elections and serving as NPR's White House Correspondent during the eight years of the Clinton administration. She is also a
regular contributor to Fox News Sunday.
Join NCQA and a broad cross-section of health care thought
leaders on April 1 as we honor these distinguished leaders. Space is limited; to purchase your tickets to the Health Quality Awards, please
call 202-333-4406 or e-mail ncqa@gardnermills.com.
Recognizing Innovations that Bridge
the
Culture Gap
A health plan in Detroit increased the number of mammography screening for African American women
as a result of targeted outreach, member incentives and a mammogram blitz. A plan in California produced a health care glossary in six languages.
Trained community residents served as ambassadors to pregnant women in western Pennsylvania. These three initiatives, along with 16 others, have been
honored in the past two years in recognition of innovative practices to reduce health care disparities.
Since the launch of the Recognizing Innovation in Multicultural Health Care awards in 2006,
NCQA has honored health care initiatives that have successfully implemented a program that have evidence of meaningful impact on services or
outcomes.
Applications for the 2008 program will be available on the NCQA Web site April 1 and the deadline for submission is May 31. Award winners will be
announced at an event in September.
Several additional projects are underway at NCQA that are focused on improving the health care of
all Americans, regardless of racial and ethnic background. A recently released toolkit, Multicultural Health Care: A Quality Improvement
Guide, sponsored by Eli Lilly and Co., provides a framework and a collection of resources for health plans seeking to promote more culturally
appropriate care. Additionally, NCQA is developing a voluntary accreditation module to help plans evaluate these efforts. Draft standards will be
pilot-tested this summer and released for public comment next fall. The standards will be released in summer 2009.
NCQA's culturally and linguistically appropriate services (CLAS) programs are
supported by a grant from the California Endowment. More information can be found at www.ncqa.org/clas.aspx.
Public Comment
Season in Full Swing
NCQA recently posted proposed changes and additions to the HEDIS® 2009 measure
set. We seek your comments and input on the proposed changes.
Significant changes for 2008 include the addition of two new measures focusing on obesity in
children and adults, as well as two measures that track care for older adults. NCQA also seeks comments on its proposal to implement the CAHPS®
Health Plan Survey 4.0H for children.
The proposed new obesity measures will assess how consistently physicians perform body mass index
(BMI) assessments among children and adults. The measure for children also tracks nutrition and physical activity.
A second set of new measures address care for older adults. These measures address pain
screening, functional status assessment, medications review and reconciliation, and advance care planning. Additionally, a new adolescent
immunization measure assesses immunization rates with a focus on vaccines appropriate
for the
adolescent population.
HEDIS® public comment will remain open through March 14. A listing of all known
public comment periods through June follows:
HEDIS 2009 Public Comment:
Ends March 14.
Physician and Hospital Quality (PHQ) Public Comment:|
Now through April 1, comment on proposed changes to the PHQ standards that evaluate how well
health plans measure and
report the quality and cost of physicians and hospitals.
Health Promotion Public Comment:
On June 2, public comment opens on a
new NCQA program that would certify programs aimed at promoting and maintaining the health of a plan's members or a company's
employees.
Visit www.ncqa.org/publiccomment.aspx to
view all materials as they become available.
Learn
More About NCQA
Accreditation This Spring
NCQA Education's Spring 2008 seminars offer a unique opportunity for those new to
NCQA's various programs. Learn the essentials of key NCQA programs and systems such as HEDIS, Accreditation and the ISS. Most events fill well
in advance; reserve your spaces as early as possible!
April 2008
Introduction to NCQA Accreditation
Apr. 23-24 | Washington, D.C.
Learn everything you need to know to effectively prepare for your NCQA Health Plan or MBHO
Accreditation survey.
Hands-On: The ISS for NCQA Accreditation
Apr. 25 | Washington,
D.C.
An immersive introduction to NCQA's Web-based survey process, the Interactive
Survey System (ISS). Best suited to those managing the preparation of an NCQA survey, leading the readiness evaluation team, or teaching others
about.
Visit www.ncqa.org/education for
an expanded calendar with detailed information behind each
seminar.
NCQA Education also offers these and other programs as corporate trainings at
organizations' headquarters. Please visit http://www.ncqa.org/tabid/89/Default.aspx for
more details.
