257842 Does NCQA diabetes recognition impact Prevention Quality Indicator (PQI) performance?

Tuesday, October 30, 2012 : 3:10 PM - 3:30 PM

Joseph Stankaitis, MD, MPH , Chief Medical Officer, Monroe Plan for Medical Care, Pittsford, NY
Laura Weisbein, PhD , Grants Coordinator, Monroe Plan for Medical Care, Pittsford, NY
Julian Allen, RN, MSN, MBA , Health Informaticist, Monroe Plan for Medical Care, Pittsford, NY
This study investigated whether National Committee for Quality Assurance (NCQA) diabetes recognition measurably impacts health outcomes by comparing Prevention Quality Indicators (PQI) rates for practitioners who had attained NCQA diabetes recognition at least 12 months prior with rates for those who had not. Data were reviewed for one year for adult patients of practitioners in Monroe County, NY (Rochester area) who are insured by Monroe Plan for Medical Care's Medicaid and Family Health Plus programs. Practitioners who achieved NCQA diabetes recognition more than one year ago (n=148) had an overall PQI rate of 776 per 100,000 as compared to 1,119 per 100,000 for those who had not (n=413), translating into a rate for recognized clinicians that was 30.4% better than the other clinicians. Lower PQI rates are better as they indicate fewer events that could potentially have been prevented. For diabetes indicators, the rate for recognized clinicians was 54.5% better; for non-diabetes indicators, 20.3% better. With measurably better PQI rates, practitioners with NCQA diabetes recognition are providing their patients with evidence-based care that results in improved outcomes on diabetes and non-diabetes indicators. For the 915 Monroe Plan patients with diabetes served by the recognized practitioners, the cost savings from all avoided PQI incidents was $188,453 ($116,982 for diabetes-related incidents alone). These cost savings can be shared with clinicians. Monroe Plan offers its physicians with NCQA diabetes recognition a diabetes care management fee of $8.50 per member with diabetes per month, yielding an overall return on investment of 2.02.

Learning Areas:
Administration, management, leadership
Chronic disease management and prevention

Learning Objectives:
Discuss Prevention Quality Indicators (PQI) performance for physicians with and without National Committee for Quality Assurance diabetes recognition. Identify implications of cost savings associated with decreased Prevention Quality Indicators (PQIs).

Keywords: Diabetes, Quality Improvement

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the Chief Medical Officer at Monroe Plan for Medical Care for fifteen years and have been the primary investigator of multiple grant projects designed to improve quality of care for chronic illnesses, including two grants to help practitioners receive NCQA recognition. Monroe Plan has received a diabetes incentive program endorsement from the New York State Health Foundation for our leadership in promoting excellence in diabetes care and outcomes.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.