NCQA: New Accreditation Program Will Rate PPOs
The National Committee for Quality Assurance (NCQA) has announced plans to begin assessing preferred provider organizations, which, although they insure 29 million more Americans than do HMOs, have escaped the rigorous performance assessment and accreditation process often applied to HMOs. Currently, PPOs cover 89 million Americans and outnumber HMOs 1,035 to 650. NCQA President Margaret O'Kane said, "In health care today the only entity that's truly being held accountable is the HMO. That's wrong. It is not safe to assume that PPOs and indemnity plans are delivering good care and service; some are and some aren't -- consumers have a right to know which is which" (NCQA release, 7/6).
The Wall Street Journal reports that in "recent years, many large employers have come to view NCQA accreditation as a leading indicator of HMO quality, and employers increasingly are requiring that stamp of approval" before offering a plan to their employees. Rating and accreditation aside, however, the popularity of PPOs is rising more rapidly than HMOs: 49% of employers offered PPOs last year, up from 21% in 1992. In contrast, just 32% of employers offered an HMO option last year, according to William M. Mercer Inc. O'Kane noted that currently, "employers don't know much about PPOs. Basically they know about the price." The new accreditation program will change that (Jeffrey, 7/7).
The Plan, Stan
NCQA plans to release PPO member satisfaction survey results during the last quarter of 1999, followed next summer by a full-fledged accreditation program to include site reviews of provider evaluation processes, quality improvement efforts and other "core systems and processes that define a PPO." As under the HMO accreditation system, NCQA will release national and regional averages to enable consumers to benchmark PPOs. Dr. Spencer Falcon, executive vice president of Private Healthcare Systems, said, "It will help distinguish those PPOs that put a good deal of effort into screening their doctors, making good medical decisions, and building systems to support their doctors from those who do not" (NCQA release, 7/6).