Taking the Lead for Accountability

Critics complain that some HMOs withhold data, but NCQA President Margaret O’Kane responds that HMOs are exemplary in measuring and reporting quality.

A recent JAMA article, critical of efforts to evaluate and report on the nation’s HMOs, attracted a good deal of attention in the trade press, including this publication (“Has the Time Come for NCQA to Get Tough with HMOs?” October 2002). We believe that this unfounded criticism deserves a response, and we appreciate the opportunity to do so here.

The article’s central criticism is based on an analysis of old data showing that poorly performing plans tended not to report their data publicly the following year. This observation was last valid in 1998, coincidentally the same year that NCQA itself first reported this disturbing pattern. The following year, NCQA established a requirement that all accredited health plans publicly report their data, effectively removing the option to “drop out” for accredited plans. Today, in fact, the vast majority (85 percent) of HMOs in NCQA’s database allow their data to be reported publicly, huge progress from the 40 percent that withheld their data in 1997. Fewer still drop out of the public reporting process; excluding plans that went out of business or merged, only five plans that reported data publicly in 2001 did not do so this year. All five were unaccredited.

But all this talk of declining percentages of “nonpublic reporters” (plans that give us data but don’t allow us to share it publicly), perhaps misses the larger point. HMOs are the one segment of health care that has broadly embraced accountability. It’s true that there are still health plans that don’t share their data publicly, but in an environment in which performance data are not available for over 70 percent of the industry — the fee-for-service sector, PPOs — shouldn’t we focus on encouraging other sectors of the system to share their results? This would seem to be more productive than criticizing efforts that have not only been embraced by the industry, but that have led to meaningful improvements in quality that have saved thousands of lives.

I suspect that NCQA and the article’s authors would find common ground on one point: We would all benefit from broader, more inclusive health care report cards. Assuming that we are in agreement, the real issue becomes how to make broader accountability a reality.

To that end, NCQA has been active on several fronts — in particular, the promotion of provider-level measurement and recognition. NCQA and the American Diabetes Association jointly sponsor the Diabetes Physician Recognition Program (DPRP), which recognizes and rewards physicians or medical groups that meet or exceed national thresholds for diabetes care. In September, we reported that physicians recognized by the program deliver consistently excellent diabetes care, outperforming the national average in key indicators, such as the percentage of patients with properly controlled blood sugar levels.

Early next year, NCQA and a coalition of large employers will introduce a “pay for quality” program that will provide incentive payments to physicians that achieve DPRP recognition. NCQA is also developing a recognition program related to excellence in cardiovascular care.

The accountability model — measuring performance, collecting data, and reporting the results publicly — is a proven approach to driving quality improvement. Its continued success, however, depends on the support and collaboration of diverse groups and individuals. We look forward to continued progress in our mission to improve the quality of health care and we invite interested parties to work with us to build on our success.

Margaret E. O’Kane has served as NCQA president since 1990.

MANAGED CARE December 2002. ©MediMedia USA

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