As the JCAHO fought for a foothold in Washington's accreditation regulations, the state's largest managed-care organization was taking an advocacy stance on behalf of the National Committee for Quality Assurance.
Group Health Cooperative of Puget Sound last spring presented a state advisory group with the results of a detailed evaluation of the NCQA's approach. The Washington-based NCQA accredits managed-care plans. The report had formed the foundation for Group Health's decision in December 1993 to pursue NCQA accreditation, said Nancy Maranville, the HMO's accreditation project director.
Over the course of several meetings and after reviewing public comments, official sentiment "crystallized" around the desire to settle on one accreditation method for the state's new certified health plans, said Tom Byron, director of information services at the Washington State Hospital Association.
That's when Group Health, a 487,000-enrollee HMO based in Seattle, stepped in and made the case for the NCQA, countering the hospital association's position that the state should go slowly on recognizing any one accreditor, Mr. Byron said.
Nancy Long, who staffs the state advisory group, said the NCQA standards "seemed to be endorsed in reactions we got from various parties," including Group Health. But she said the standards "were validated simply on their merits" as comprehensive and reasonable-close to what the state would have come up with on its own.
The inclusion of the NCQA in the Aug. 24 draft of regulations is the first time the group's standards were specifically cited in a state initiative, said Margaret O'Kane, NCQA president.
But, she added, "that actually wasn't our idea. We found out about that (during the rule-making process), and we had to think about whether we wanted to be included."
That's because the NCQA has positioned its standards as a rigorous challenge, one that only 30% of HMOs can meet on the first try (June 6, p. 6).
"We do not want to push ourselves as the condition of doing business" in certification efforts, Ms. O'Kane said. But the NCQA decided that Washington's healthcare reform had progressed enough to handle the standards, she said.
However, Mr. Byron said the fledgling health plans that form under the state's reform law may not be ready for such rigor, especially when a number of longstanding HMOs "that are no slouches" are "going to have some trouble meeting the standards the first or even the second time around."
Group Health's Ms. Maranville said the company considered the NCQA standards strong but not too prescriptive, allowing organizations to lay out their own proposals for meeting standards but then holding them to those proposals.
She added that a principal concern among managed-care companies is the cost of external regulation and the specter of having to conform to multiple review organizations.
Group Health's decision to gear up for the NCQA's version-its first survey will be in July 1995-raised the possibility that it would face multiple review requirements if the NCQA standards didn't prevail, she said.
When the state asked for comment on what accreditation approach to take, Group Health "raised the flag and said this was an opportunity we should consider," Ms. Maranville said.