CALIFORNIA: CHOICE OF HMO REVIEW ORGANIZATIONS CRITICIZED
The state Department of Corporations' (DOC) first-everThis is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
selection of an outside contractor to evaluate the quality of
care provided by state health plans "has drawn strong protests
from" consumer organizations and the HMO industry. The DOC
announced yesterday it has awarded state contracts to the Joint
Commission on Accreditation of Healthcare Organizations (JCAHO)
and the Institute of Medical Quality (IMQ), a subsidiary of the
California Medical Association, "to evaluate up to 32 California
HMOs" (Olmos, LOS ANGELES TIMES, 8/13). The evaluations will be
used by the DOC "in the licensure of these health plans"
(JCAHO/IMQ release, 8/12).
CONTROVERSY: It is "no secret for the last several years
the California Medical Association has had a very antagonistic
attitude toward managed care health plans," Alan Tomiyama,
spokesperson for the California Association of HMOs, said. He
added, "This causes us very grave concerns" (BLOOMBERG BUSINESS
NEWS/INVESTOR'S BUSINESS DAILY, 8/13). Another reason consumer
groups and the HMO industry oppose the selection of JCAHO and IMQ
is the groups lack of "experience in evaluating HMO quality."
TIMES notes that the JCAHO has completed only eight evaluations
of the nation's more than 1,000 HMOs and IMQ "has never conducted
an HMO review" (8/13).
MORE: "The controversy over the selection is more bad news
for the" DOC, which has received frequent criticism by
legislators and consumer groups "for having an overly protective
attitude toward the industry it regulates," according to the
TIMES. Complaints from "consumer groups and others" charge that
the DOC's quality reviews "were sometimes not completed by their
RESPONSE: DOC officials said that its decision to turn the
HMO quality reviews over to an outside group "is part of an
effort to improve oversight over health plans." DOC attorney
Anita Ostroff said, "We didn't feel we had the resources or the
staff to really ensure the public that the plans are being held
accountable for overall healthcare quality" (8/13). The JCAHO
and the IMQ will evaluate 13 health plans in the state by June
30, 1997, and up to an additional 19 by June 30, 1999 (JCAHO/IMQ