A much-ballyhooed national managed-care quality report card project that's supposed to establish uniform standards of measurement for health maintenance organizations got under way without the cooperation of one of the industry's leaders.
Minnetonka, Minn.-based United HealthCare Corp., which started the report card bandwagon rolling last year by unveiling its own quality measurement system, declined to participate in the year-long project, which involves 21 HMOs covering 9.6 million enrollees. The HMOs each agreed to contribute $100,000 to the project and to have their "grades" published at the end of the year.
"We are laying the foundation for the development of a national report card that both the (Clinton) administration and alternative reform proposals (want)," said Patricia Nazemetz, director of corporate benefits of Xerox Corp., Stamford, Conn., and chairwoman of the National Committee for Quality Assurance, Washington, which is guiding the project.
But the HMO industry's initial attempt at setting national standards won't have the participation of United HealthCare, which owns or manages health plans in 20 cities covering 23 million beneficiaries through more than 10,000 employers, insurers and government agencies.
United said its participation in the national report card project would be an unnecessary duplication of its own efforts to measure quality, which is expensive and time-consuming.
"We have a report card out already," said Sheila Leatherman, president of United's Health Care Policy and Evaluation. "It would be confusing to be in two different report card projects." She said United would be ready to comply with national standards "when that time comes."
The HMO operator caused a stir last March when it released what was billed as the nation's "first report card on healthcare" at a press conference in Washington. What set United's efforts apart from most other HMOs' was its ability to make national comparisons because of its size (March 15, 1993, p. 12).
Since then, two other health plans-Blue Bell, Pa.-based U.S. Healthcare's Pennsylvania HMO and Oakland, Calif.-based Kaiser Permanente's Northern California unit-have published similar report cards.
Healthcare purchasers publicly applauded such efforts by HMOs to measure quality but voiced concerns about the reports' utility because they were based on the plans' own internal measures rather than uniform standards (Jan. 10, p. 41).
The industry's lack of such uniformity has hampered efforts to convince both public and private consumers that HMOs represent a major improvement over the way healthcare typically is delivered.
The NCQA project will test the major portions of the Health Plan Employer Data and Information Set, or HE DIS, which is composed of 60 performance measures covering quality, enrollee satisfaction, utilization and financial data that have been under development since 1989 (Dec. 20/27, 1993, p. 62).
Margaret O'Kane, NCQA's president, said the report card project seeks to involve as many plans as possible because of the need for independent and impartial criteria to verify HMOs' performance.
She downplayed United's lack of support, noting Kaiser's and U.S. Healthcare's participation. "I think we've got most of the big players in the country. (Without Kaiser and U.S. Healthcare), there would have been a real problem," she said.