Many people believe high-quality healthcare requires more services and must cost more. But is that really true?
A tool from the National Committee on Quality Assurance shows that some health plans delivering high-quality care also do better at avoiding waste. NCQA’s “Relative Resource Use” (RRU) measures help illustrate how services like doctor visits and medical procedures relate to quality. They reveal that overall, the number of services used to treat people often has little to do with the quality of care. RRUs can help identify plans that provide high quality using fewer costly resources like hospital stays and surgeries.
What are RRUs?
RRUs measure use of services like doctor visits, hospital stays, surgeries, drugs and other care for people with five common, chronic diseases: asthma, cardiovascular disease, COPD, diabetes and hypertension. These conditions account for over 50 percent of all health spending, and people with them do substantially better if they get effective treatments and avoid ineffective care. Combined with other NCQA HEDIS measures, RRUs are intended to reveal value, or the benefit that people get for the services provided to them.
How are RRUs calculated?
NCQA RRUs represent actual service use, based on audited data from health plans. The Committee “risk-adjusts” to account for factors such as age, gender and serious health conditions, so that plans serving different members can be compared. Because NCQA lacks payment rates that plans negotiate with providers, RRUs are calculated with standardized prices. Results are divided into five major categories: inpatient hospital care; “evaluation and management” (generally, physicians figuring out what patients need); surgery and procedures; outpatient prescription drugs; and laboratory and imaging services.
NCQA puts RRU results into charts that show resource use by each plan, compared with other plans, for each of the five diseases, after adjusting for differences in member risk. Results are compared among plans at both the national and local level.
To learn more about Relative Resource Use measures, go to http://www.ncqa.org/Portals/0/HEDISQM/RRU/NCQA%20RRU%20Fact%20Sheet%20for%20HEDIS%202016.pdf