NCQA: Proposes New HMO Performance Standards
The National Committee for Quality Assurance has proposed new "standards" for its HMO rating system requiring plans, for the first time, to detail how they treat chronic illnesses. Under several of the new standards, health plans will "not only ... keep track of their attempts to treat the conditions, but also what effect the treatments have on patients," the Scripps Howard/Detroit News reports. "This new set of measures will show how well health plans are caring for some of their sickest members. That's one of the true measures of a health plan -- will it take care of me if I get sick?" said NCQA President Margaret O'Kane. Although data collected in the NCQA's Health Plan Employer Data and Information Set is voluntarily reported by the HMOs and infrequently audited, some employers use the performance reports when selecting health plans. Under the proposed guidelines, HMOs would have to report whether they offer counseling to women entering menopause, as well as how well they screen members at high risk for chlamydia. Asthma care would be measured by the number of emergency room visits asthma patients needed and whether HMOs provided appropriate asthma drugs. Plans would also be evaluated on how well they control high blood pressure. Two other standards that have been added provisionally this year and could become mandatory next year would look for cholesterol management after heart attacks and the quality of comprehensive diabetes care. The proposed standards are open for comment through March and the final version will be announced in June (Bowman, 2/4).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.