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

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.