Annals of Internal Medicine
August 17, 2004
Diabetes Care Quality in the Veterans Affairs Health Care System and Commercial Managed Care: The TRIAD Study
By Eve A. Kerr, MD, MPH, et al
We believe that this is the first study to use equivalent instruments and methods to compare quality of diabetes care for patients treated in the VA system with quality for those in commercial managed care systems. We should note that the average results for diabetes quality among the commercial managed care plans participating in this study are at or near the top of diabetes performance when compared with national results for commercial plans participating in the National Committee for Quality Assurance accreditation process. Despite this relatively high level of performance in the commercial plans, we found that the processes of care and 2 intermediate outcomes for VA study participants were better than or as good as those for commercial managed care participants. In many cases, the observed differences in quality of care between VA and commercial managed care were large.
…as an integrated health care system, the VA system has implemented several simultaneous, national-level strategies, such as an integrated electronic medical record, unified nationwide guidelines, service integration, alignment of payment incentives, and effective performance monitoring. While almost all commercial managed care plans also had established diabetes quality improvement and monitoring systems, the Chronic Care Model suggests that changes in several domains of care and investment in quality by organizational leaders are necessary to move the quality needle effectively.
Our results suggest that a federally sponsored national health care organization can provide care that is equivalent to or better than that provided by high-performing commercial managed care plans.
http://www.annals.org/cgi/content/full/141/4/272
Comment: So much for “the government can’t do anything right.”