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NCQA Is Setting Standards for Managed Care Plans

NCQA Is Setting Standards for Managed Care Plans

WASHINGTON--As managed care health plans continue to proliferate,
the need has increased for ways to differentiate and compare plans,
and give purchasers and consumers information on which to base
decisions about medical coverage.

Accreditation of health plans by a national, standards-setting
organization is becoming an important selling point in the fiercely
competitive managed care environment.

The National Committee for Quality Assurance (NCQA) is the leading
private, not-for-profit organization that assesses and accredits
the quality of managed care plans, primarily HMOs. The 5-year-old
Washington, DC-based NCQA, which began reviewing health-care plans
in 1993, aims to provide information that enables both purchasers
and consumers to compare plans based on specific quality factors.

At this point, NCQA has reviewed about half of the nation's 574
HMOs. A team of doctors and managed care experts conducts both
on-site and off-site reviews, which consist of examinations of
documentation and medical records, interviews with health plan
employees, assessment of member service systems, and 2 to 4 days
of observation.

This information is then compared against 50 nationally recognized
standards for managed care organizations in six categories (see
table).

Standards for full accreditation are rigorous; 14% of the plans
evaluated so far have been denied accreditation, while just 35%
have been granted the full 3-year seal of approval. Other options
include 1-year accreditation, accompanied by a list of recommended
changes with reevaluation in 1 year, and provisional accreditation
for a year for those plans that meet some NCQA standards but do
not qualify for higher levels of accreditation.

To help consumers, NCQA puts out an Accreditation Status List
that provides plan data arranged by state or alphabetically. This
June, a new Accreditation Summary Report will provide more details
on individual plan accreditation decisions as well as show how
a particular plan measures up against the average in each category
of standards. NCQA data can also be accessed by computer .

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