NCQA Standards Focus on PPO Performance

Preferred provider organizations (PPOs) that are seeking National Committee for Quality Assurance (NCQA) accreditation will now be required to report clinical quality results through HEDIS.

While nearly 150 million Americans are enrolled in a PPO, most of these plans do not collect and report quality data. In 2006, 80 PPOs submitted HEDIS data to NCQA. A similar number are expected to do so this year.

All health plans, including HMOs and PPOs, will now be evaluated under the same set of standards.

The move was applauded by a broad cross-section of 41 employers, labor unions, policymakers, and consumer advocates, including 3M, Consumers Union, the AFL-CIO, Ford, GE, Pfizer, and UPS.

Using a common set of standards to evaluate health plans will allow consumers, employers, and other purchasers to compare the performance of all plans and to make the choices that best fit their needs.

PPOs cover two thirds of all privately insured Americans, “but we know little about the quality of care they deliver,” says NCQA President Margaret E. O’Kane.

NCQA is building on the success it has had with measuring quality of managed care organizations “by asking PPOs to do what HMOs have done for years,” says O’Kane.

Considerably more information about NCQA’s new Health Plan Accreditation Standards is available at «».