Managed Care


Handful of PPOs Agree To Take Part In NCQA Review

MANAGED CARE December 1999. © MediMedia USA
News and Commentary

Handful of PPOs Agree To Take Part In NCQA Review

MANAGED CARE December 1999. ©1999 MediMedia USA

A handful of leading PPOs have agreed to test the National Committee for Quality Assurance's first tool for measuring PPO quality of care. NCQA modified its Consumer Assessment of Health Plans Survey, which it has used as part of HEDIS to report member satisfaction with HMOs. The revisions to the survey will allow PPO enrollees to give feedback about their experiences in such areas as getting needed care, customer service, and claims processing. The survey will become a key piece of NCQA's PPO-accreditation program, which will be released early next year.

In a separate development regarding quality measurement, the American Accreditation HealthCare Commission/ URAC will soon promulgate national accreditation standards for external-review organizations. URAC says final standards are likely to fall along the lines of: scope of reviews; qualifications of reviewers; and components of the process itself, including documentation, time frames, and notification of decisions. The commission is working with a handful of organizations that have agreed to test its standards.

One final tidbit: The Joint Commission on Accreditation of Healthcare Organizations has developed a set of proposed performance measures for hospitals. In another break from its tradition of focusing on hospitals' internal processes, JCAHO plans to measure outcomes for patients with coronary artery disease, heart failure, pneumonia, and pregnancies. The Joint Commission will also provide data about surgical procedures and complications. Results will be compiled into report cards that JCAHO says will allow comparisons of performance across hospitals.


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