The Model of Preventive Medicine

Kaiser Permanente Leads Nation in NCQA Quality Measures for Commercial and Medicare Plans

One out of every three American adults has hypertension, according to the Centers for Disease Control and Prevention. Fewer than half of those have it under control, putting them at greater risk of developing heart disease or stroke. These numbers are dramatically different for Kaiser Permanente members.

Nearly 90 percent of Kaiser Permanente members have their blood pressure under control, according to the 2016 National Committee for Quality Assurance’s Quality Compass® data. Using a hypertension control program that is praised and held up as a national model, Kaiser Permanente health plans – supported by Permanente physicians – in the Mid-Atlantic States, Northern California, Georgia, Colorado and Hawaii are the top five commercial health plans in the nation for controlling high blood pressure, out of nearly 350 health plans considered. And Kaiser Permanente commercial plans in Southern California and Hawaii are also in the top 10 for hypertension control, tied for seventh overall.

Kaiser Permanente’s commitment to prevention and early detection and treatment of diseases doesn’t stop with high blood pressure. The organization’s health plans were also named No. 1 in the nation for 20 other measures, including breast cancer screening, postpartum care and comprehensive diabetes care (blood pressure control).

This is the eighth year in a row that Kaiser Permanente has had the most No. 1 rankings among U.S. commercial health plans.

Medicare Plans’ Rankings

When looking at 2016 NCQA dataset for the country’s Medicare plans, this is the seventh year in a row that a Kaiser Permanente Medicare plan is No. 1 in the nation for breast cancer screening. For Medicare plans, Kaiser Permanente is also ranked No.1 in five other effectiveness-of-care measures, including colorectal cancer screening for the fourth year in a row.

“We are proud of the results from NCQA, but more importantly, we are proud that Kaiser Permanente is proactive in helping our members stay healthy,” said Michael Kanter, MD, executive vice president and chief quality officer, The Permanente Federation, the national organization for the nearly 19,000 physicians who exclusively provide care to Kaiser Permanente’s members. “Our highly skilled physicians, nurses, clinicians, front-line staff and care teams are dedicated to doing what’s best for the member.”

The annual Quality Compass database includes scores from the Healthcare Effectiveness Data and Information Set, or HEDIS, a tool that is used by more than 90 percent of America’s health plans to measure performance on important dimensions of care and service, including medication management, maternal care and respiratory conditions.

“Our focus on prevention and early intervention saves lives,” said Patrick Courneya, MD, executive vice president and chief medical officer for Kaiser Foundation Health Plan and Kaiser Foundation Hospitals. “Our consistent year-after-year high-quality performance on these important health care measures also reflects a culture of continuous improvement that helps members achieve both physical and mental well-being.”

The following lists the top marks Kaiser Permanente health plans received in the two areas of commercial plans and Medicare.

NCQA Quality Compass for Commercial Plans

While Kaiser Permanente was No.1 in 21 of the 48 care measures rated in NCQA’s Quality Compass dataset for commercial plans, no other health plan had more than four No. 1 rankings.

Measure Kaiser Permanente Region/Plan
Controlling High Blood Pressure Mid-Atlantic States
Breast Cancer Screening Mid-Atlantic States
Adult BMI Assessment Georgia, Mid-Atlantic States
Weight Assessment for Children/Adolescents – BMI Percentile Southern California
Counseling for Nutrition for Children/Adolescents Hawaii
Counseling for Physical Activity for Children/Adolescents Hawaii
Human Papillomavirus Vaccine for Female Adolescents Mid-Atlantic States
Chlamydia Screening in Women – Total Georgia
Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis Northwest
Use of Spirometry Testing in Assessment and Diagnosis of COPD Southern California
Pharmacotherapy Management of COPD Exacerbation – Bronchodilator Hawaii
Persistence of Beta-Blocker Treatment After a Heart Attack Colorado
Comprehensive Diabetes Care – Eye Exams Mid-Atlantic States
Comprehensive Diabetes Care – Blood Pressure Control <140/90 Mid-Atlantic States
Use of Imaging Studies for Low Back Pain Hawaii
Follow-up Care for Children Prescribed ADHD Medications – Continuation and Maintenance Hawaii
Metabolic Monitoring for Children and Adolescents on Antipsychotics Hawaii
Annual Monitoring for Patients on Persistent Medications – Digoxin Georgia
Annual Monitoring for Patients on Persistent Medications – Diuretics Georgia
Aspirin Use and Discussion – Aspirin Use Northwest
Prenatal and Postpartum Care – Postpartum Care Northern California

NCQA Quality Compass for Medicare Plans

There are 29 effectiveness-of-care measures tracked in the NCQA Quality Compass for Medicare dataset for 2016. Out of the nearly 350 Medicare health plans in the nation rated by NCQA, Kaiser Permanente had the most No.1 rankings for the sixth consecutive year; no other health plan received more than three No.1 rankings.

Measure Kaiser Permanente Region/Plan
Breast cancer screening Mid-Atlantic States
Colorectal cancer screening Mid-Atlantic States
Adult BMI assessment Georgia, Mid-Atlantic States, Northern California (tie along with 16 other plans)
Controlling high blood pressure Hawaii
Disease-modifying anti-rheumatic drug therapy for rheumatoid arthritis Hawaii
Follow-up After Hospitalization for Mental Illness 30 Days Georgia

The source for data contained in this publication is Quality Compass® 2016 and is used with the permission of the National Committee for Quality Assurance (NCQA). Quality Compass 2016 includes certain CAHPS data. Any data display, analysis, interpretation, or conclusion based on these data is solely that of the authors, and NCQA specifically disclaims responsibility for any such display, analysis, interpretation, or conclusion. Quality Compass is a registered trademark of NCQA. CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).