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NCQA Wonders: Who Keeps Tab On Consumer Plans?

MANAGED CARE November 2005. © MediMedia USA
News and Commentary

NCQA Wonders: Who Keeps Tab On Consumer Plans?

MANAGED CARE November 2005. ©MediMedia USA

Each year the National Committee for Quality Assurance releases its huge report on what's going on in the health care industry: The State of Health Care Quality.

It's professionally presented and packaged, and always chock full of the sort of information that can keep those who toil in managed care, as well as those who report on it, busy for months. (For instance, see the chart "Quality Improves at Nation's Health Plans.") This year's report, the 2005 version, is no exception. One can almost start taking it for granted. However ....

There are, it seems, some differences between this year and prior years. Last year, plans that cover 23 percent of Americans participated in the NCQA process; this year the participating plans cover 21.5 percent of Americans. This seems to be a function of the rise of consumer-directed health plans and PPOs. The NCQA notes that, "with few exceptions, these plans tend not to measure or report on their performance."

Of course, no health plan has to report to the NCQA. Participation is voluntary.

"An HMO that says 'I don't want my stuff reported' doesn't report it," Uwe Reinhardt, PhD, well-known professor of health economics at Princeton University, told Managed Care back in October 2002. "Imagine General Motors saying to the Financial Accounting Standards Board, 'Actually this year was not so good so we've decided not to have a financial report.' That's roughly what the HMO industry has said, which is of course quite ridiculous."

Margaret E. O'Kane, the NCQA's president, is an articulate and wily debater who's quite capable of defending her organization. For instance, this publication ran a story about a study in the Journal of the American Medical Association critical of the NCQA's efforts. This also occurred in October 2002; that must have been an interesting month. O'Kane came out swinging in a "viewpoint" in our December 2002 issue in which she said that the data were flawed. She made many other points as well, but here are the ones most germane to this account:

"HMOs are the one segment of health care that has broadly embraced accountability. It's true that there are still health plans that don't share their data publicly, but in an environment in which performance data are not available for over 70 percent of the industry — the fee-for-service sector, PPOs — shouldn't we focus on encouraging other sectors of the system to share their results? This would seem to be more productive than criticizing efforts that have not only been embraced by the industry, but that have led to meaningful improvements in quality that have saved thousands of lives."

So what else is different this year? Well, for one thing, the NCQA is joining forces with U.S. News & World Report to create rankings of America's Best Health Plans. This is not a first, says NCQA spokesman Brian Schilling. "We did something similar for three years in the late '90s." This, one assumes, will be as avidly followed as some of the other rankings seen in mass-market magazines: ones for hospitals, cities, and colleges come to mind.

Where does this leave us? Well, you have the NCQA obviously trying to do what experts such as Reinhardt have said for years that they must do: become relevant to consumers.

This push comes at a time when fewer people belong to the type of health plans — HMOs and point-of-service — that participate in the NCQA's accreditation process. Still, the calls for more transparency in health care have been deafening.

It'll be interesting to see how this all plays out.