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MANAGED CARE March 2007. ©MediMedia USA

News and Commentary

NCQA Toughens Evaluation of PPOs

Preferred provider organizations will be evaluated on the same set of standards, clinical measures, and patient experience ratings that the NCQA uses to evaluate HMOs and POS plans. Under the new standards, PPOs seeking NCQA accreditation would be required to report clinical quality results using HEDIS.

Nearly two-thirds of privately-insured Americans are enrolled in a PPO. That amounts to 150 million people. In 2006, 80 PPOs voluntarily submitted HEDIS results to NCQA, but most PPO plans do not participate.

This collection of performance data will allow consumers, employers, and other purchasers of health care to compare the performance of all plans and to make appropriate choices.