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VOL. 127 | NO. 213 | Wednesday, October 31, 2012

Report: Health Care Improving in Tennessee


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Health care is showing improvement in Tennessee thanks to some of the strongest health care plans in the South and an increased focus on patient-centered medical practices, according to the annual State of Health Care Quality report released Tuesday, Oct. 30, from the National Committee for Quality Assurance (NCQA).

Eleven commercial health care plans in Tennessee are accredited by NCQA and three plans – Aetna and CIGNA HMOs, and the BlueCross BlueShield (BCBS) of Tennessee PPO – rated “Excellent” in the 2012 report. The Tennessee plans are the highest-rated plans in the U.S. Department of Health and Human Services’ South Central region.

“This recognition from the NCQA shows that we are doing a great job serving our members. BlueCross BlueShield employees are doing their jobs with commitment and striving to do excellent work every day,” said Gary Tanner, communication specialist with BCBS of Tennessee.

The NCQA’s accreditation program has three levels – accredited, commendable and excellent.

“Plans rated excellent do very well on both clinical quality measures and patient experience ratings,” explained Sarah Thomas, NCQA vice president of Public Policy, and Peggy Reineking, NCQA director of Physician Recognition Programs, in an email.

These elements also go into the NCQA’s health plan rankings, which show how all the plans in the country line up against each other.

The report summarizes the quality of care received by a record 125 million Americans, or 40 percent of the U.S. population, an increase from 118 million people a year earlier.

“We see Tennessee excelling in health care in the commitment to quality and value of purchasers, like the businesses in Memphis and the state Medicaid agency, as well as the spread of Patient-Centered Medical Homes.”

–Sarah Thomas
Vice president of public policy, NCQA

In general, the NCQA report found that health plans across the country are paying more attention to obesity. The report’s Adult Body Mass Index assessment was the most improved out of the more than 40 quality measures, rising an average of 17 percentage points across all health plans.

Medicare Advantage plans were this year’s most improved, and accredited plans were found to perform better on more than 75 percent of quality measures.

Tennessee is one of the states recognized by the report as also making strides in health care delivery.

“We see Tennessee excelling in health care in the commitment to quality and value of purchasers, like the businesses in Memphis and the state Medicaid agency, as well as the spread of Patient-Centered Medical Homes (PCMH),” said Thomas and Reineking. “A PCMH is a primary care practice, led by a physician (usually an internist or family doctor), that brings together a team of medical professionals to coordinate and personalize all of your medical care. The ‘home’ refers to the doctor’s office.”

The PCMH program started six years ago after primary care specialty societies approached NCQA with the idea of translating their joint principles into an evaluation program.

“The PCMH program is a way to show sponsors of patient-centered medical home programs which practices really have figured out how to do team-based care, provide better access so patients don’t need to go to the emergency room, and use health information technology to coordinate and track their patients over time and across settings,” said Thomas and Reineking.

The goal of PCMH practices is to personalize patient care. As of September, 374 physicians in Tennessee are NCQA Recognized out of 23,078 nationally NCQA Recognized PCMH physicians.

“The national conversation has been about the goal to improve quality care,” said Dr. Susan Nelson, family physician and medical director at Harbor of Health, a UT Medical Group practice, which has been involved with the NCQA since 2006 and became one of the first PCMH-certified practices in Memphis in August 2011. “Some PCMH principles include coordinating specialty care, providing patients with easy access and tracking referrals.”

Next year Harbor of Health hopes to establish a Web portal that will allow patients to electronically access their charts with a PIN and then make appointments and request prescriptions.

“The idea is that the patient will be able to interact with their medical records, look up information, get access to email to their doctors and conduct virtual visits. It’s truly modern medicine,” said Nelson, who explained that, for example, patients with high blood pressure will be able to email their blood pressure readings to their doctors. They can then have a conversation by email, change prescriptions if needed and potentially eliminate some doctor visits. “The benefit for the patient is they are more involved with their care, with more direct access to their doctors. Instead of receiving all the time, it is more of a two-way conversation.”

BlueCross BlueShield of Tennessee is a formal sponsor of the PCMH program, which pays health practices’ fees for onsite training and pays a fee to practices recognized for care management.

“The program enables and provides physicians with an effective roadmap to transform to a true patient-centered medical home,” said BCBS of Tennessee staff in a prepared statement. “Our organization considers NCQA to be the leading authority on recognition of PCMH sites.”

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