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Substantial Increase Seen in PPO Quality Reporting

MANAGED CARE November 2007. © MediMedia USA
News and Commentary

Substantial Increase Seen in PPO Quality Reporting

MANAGED CARE November 2007. ©MediMedia USA

Back in 2005, the National Committee for Quality Assurance called on PPO plans to report HEDIS data, which are clinical measures of quality, with 80 plans — ranging from national carriers to smaller insurers — answering the call. This year, 83 commercial and 58 Medicare PPOs, covering more than 21 million Americans, reported audited HEDIS results. Those findings are in the NCQA's "The State of Health Care Quality 2007."

Margaret O'Kane, president of the NCQA, says she is heartened by the increase in HEDIS reporting by PPO plans. "These plans, which just two years ago reported little to no quality data, are embracing the quality agenda," O'Kane says.

More than 6 in 10 Americans who receive health coverage through their employer are enrolled in PPOs, up from less than 40 percent 10 years ago.

"This year, we had much more widespread reporting from Medicare PPOs, which accounts for a fair part of the increase," says Jeff Van Ness, an NCQA spokesman. As a result of the increase in reporting, the NCQA is able to report on 22 HEDIS measures of clinical quality for PPO plans and eight measures of consumer experience.

"But it's not just that there were more PPOs reporting back," says Van Ness. "PPOs that had reported on a partial set of HEDIS measures in 2006 are now reporting on a full set of data measures in 2007. The data are much more robust — even data reported by the same plans year after year."

Interest in PPO quality reporting has expanded to the public sector as well, according to the report. The Medicare program and the federal Office of Personnel Management now require PPO plans to engage in HEDIS reporting.