Washington, D.C. – A recent national review of medical care found that Medicare recipients who belong to managed care plans receive better preventive screening services for major conditions than beneficiaries enrolled in the traditional Medicare program. Members of the Alliance of Community Health Plans (ACHP) exceeded and in some cases more than doubled the preventive care percentages of patients screened in the traditional fee-for-service system.
In its recent major national study, the Dartmouth Atlas of Health Care reported the results in traditional fee-for-service medicine across the nation. According to the Atlas, only 28% of women aged 65-69 had mammograms during the study period. Protocols call for women in this age group to have a mammogram every two years. “By contrast, women receiving their care from physicians participating in not-for-profit and provider based health plans averaged more than 80%,” said Dr. Ed Marine, senior health care consultant at HealthCarePlan in Buffalo, New York, Vytra Health Plans of Long Island and the Alliance of Community Health Plans.
“The reason why these plans have done better is no mystery. The best of them have always measured performance and provided regular feedback to participating physicians making it possible for them to improve quality,” said Dr. Marine. Health plans with a determination to partner with physicians, time and time again have demonstrated superior performance in health care services.
Similarly, only 45% of people with Diabetes had eye exams through fee-for-service Medicare according to the Atlas. “The health plans scored almost 20 points higher and their trends continue upward,” said Dr. Marine.
Why is there such a disparity? Daniel Wolfson, president and CEO of the Alliance of Community Health Plans, believes it begins with a commitment to quality that includes constructive partnerships with providers and patients. “In meeting the needs of patients, regardless of their age, we simply perform at a higher standard,” said Wolfson.
“Health plans make investments in data systems to determine what works and what does not work. They also advance research and support clinical trials and quality improvement to promote evidence about the effectiveness of care and treatment,” Wolfson added. Health plans also averaged high scores in administering beta blocker treatment after heart attacks and in follow-up after hospitalization for mental illness.
The Alliance of Community Health Plans (ACHP) is a national association of 26 not-for-profit and provider based health plans.
Physicians from ACHP’s member plans are available to provide additional information to reporters and editors.