BUFFALO, NYCancer care services vary widely among health care
plans in the United States, speakers told the Presidents Cancer
Panel at a meeting hosted by Roswell Park Cancer Institute.
Suggestions for helping standardize care included use of outside
accreditation centers and adoption of national practice guidelines,
although the methodology to be used to develop such guidelines
remains open to debate.
Rigorous assessment of health plans is needed to provide a way
for patients to consistently compare plans in their region and
understand what they are being offered, said Cary Sennett, MD,
PhD, executive vice president of the National Committee for Quality
Assurance (NCQA). Dr. Sennett added that employers are demanding that
plans offered to their employees be accredited and demonstrate
Accreditation from the NCQA is a voluntary process. About 20% of all
plans surveyed by the NCQA fail to achieve accreditation, and only
one-third of plans that go through the process receive the
committees highest accreditation.
Our accreditation process and performance measurement systems
are the gold standard of evaluating health plans, Dr. Sennett
said. The answers we compile in our accreditation process serve
as the core of most national report cards and help consumers consider
plans. We require ongoing evaluations and a commitment to science for
plans to pass.
NCQA research has shown a wide variety in the performance of managed
care plans, including the areas of cancer prevention and screening (see
Table). We see in these numbers not only that there is a
wide variation among plans, but also that the national average for
life-saving methods of cancer prevention may not be at the level
patients need, Dr. Sennett said.
While the NCQA offers a national accreditation process for managed
care organizations, the industry itself is working toward the
development of guidelines to minimize the apparent inconsistencies in
care. This has been an area of rapid growth this decade,
said George Isham, MD, speaking for the American Association of
Health Plans (AAHP). The AAHP represents more than 1,000 HMOs,
preferred provider organizations and other similar managed care plans.
Managed care organizations need to express a philosophy of care
that includes a partnership between patients and physicians and
provides comprehensive health care for a broad spectrum of
patients, said Dr. Isham, medical director and chief health
officer for Health Partners, a Minnesota-based managed care organization.
The AAHP sees a need for guidelines that are drawn from existing
scientific guidelines but also include physician input. Most
academic centers base their guidelines on science; our guidelines are
derivative, based on professional guidelines or other sources,
Dr. Isham said. Such guidelines offer the opinion of local physicians
in addition to experts, and may differ in some of the details from
the guidelines developed by physicians at academic institutions.
A new resource for patients and physicians will be launched in
December 1998the National Guideline Clearinghouse, available on
the Internet at www.guideline.com. This database of multiple
guidelines will allow providers, payers, and patients to research
accepted care and compare different organizations guidelines
for specific diseases.