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    September-2016
 
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Group Seeks To Keep Eye On PPO Health Plans

A continued focus in the CDH environment is on accountability in healthcare and making sure consumers are getting the best possible services for the money they pay.  As part of this accountability, a group that has monitored health maintenance organizations for a decade is seeking to rein in preferred provider networks and the 150 million Americans they serve.
 
The National Committee for Quality Assurance said it will require carriers of preferred provider plans to undergo a series of extensive evaluations before they accredit the companies. It's believed to be the first concerted attempt by any organization to keep tabs on health insurers.

Health insurers have largely have gone unchecked by either government officials or private groups, but some are now seeking increased accountability for PPOs. Medicare and federal employees groups require carriers to report widely accepted data, and President Bush has called upon U.S. agencies to boost quality and price transparency.

The group that will do the evaluations, also known as NCQA, has obtained suggestions from a number of parties both inside and outside the industry, officials said. It plans to hold a public comment period between now and March 30 on its proposed guidelines.

NCQA hopes that its findings become the standard for consumers seeking information on their health coverage in the same vein as Consumer Reports Magazine or J.D. Power surveys.

Margaret O'Kane, the group's president, said she hopes the standards proposed by NCQA will lead to more active insurers that take part in preventative care and disease management programs.

"People don't want a passive claims payer," she said. Currently, about 80 PPO insurers voluntarily provide data to NCQA, O'Kane said. They include such major carriers as WellPoint Inc. She said it shouldn't be too much of a stretch for those companies, which now have their HMO programs accredited through NCQA, to include PPOs in the mix.

The findings from reports have been available on NCQA's web site, but the group plans to make its reports more extensive and require them of all carriers.  NCQA also is looking to increase the weighting it gives to patient care when determining what a carrier's final evaluation should be, officials said.

Ultimately, patients would be able to assess health care plans by their various regions as well as by how well they treat a particular illness. For example, plans will be ranked on how well they cater to diabetes patients, said John Friedman, NCQA spokesman.

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