The National Committee for Quality Assurance, under pressure to satisfy an increasing public hunger for information on healthcare, last week released the status of all 156 accreditation reviews it's conducted to date on HMOs.
The Washington-based not-for-profit organization, which has accredited managed-care plans for about three years, had maintained a policy of disclosing results of individual reviews on request.
But as the healthcare debate has heated up, there's been "increasing demand by consumers and the press for an entire list of accreditation," said Marybeth Krovisky, the NCQA's vice president for accreditation.
The higher visibility for the NCQA process makes it a logical tool for comparing health plans nationwide, and that potential was emphasized by NCQA in its pitch last week to a consumer audience.
If the public begins to make decisions based in part on the NCQA's five-grade system, providers could feel pressure from an HMO partner to improve clinical and administrative performance in ways that enhance the HMO's chance of getting fully accredited.
The accreditation standards, which include evaluations of quality improvement, physician credentialing and utilization management, "call for active participation by providers," Ms. Krovisky said.
Full accreditation is not easy, and that's the way it's meant to be, said Ms. Krovisky. "Because of our high standards, we find that a large percentage of plans do not achieve full accreditation on their first review." Of the 118 plans for which accreditation decisions have been made, 35 of them, or 30%, have full accreditation, which is good for three years (See chart).
Some of those moved up in a second review after initially earning a one-year accreditation, which credits them for meeting most standards and lists areas for improvement, or provisional accreditation, in which an HMO meets some standards but needs to show progress in order to move up.
The NCQA list showed that 40% of the 118 plans had one-year accreditation and 23% were given provisional status. Three HMOs were denied accreditation, and five are requesting a review of their initial status before it becomes public. Another 38 plans are still in mid-review.