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 .