The National Committee for Quality Assurance is planning to accumulate all available quality-related information about HMOs in one comprehensive database, allowing quick and relatively inexpensive comparisons among the nation's health plans.
The database, to be operational by August, will include standardized reporting of HMO performance as measured by the Health Plan Employer Data and Information Set, or HEDIS.
It also will include consumer-oriented summaries of the results of accreditation reviews or follow-up surveys conducted by the NCQA after July 1, 1995.
The summary report, listing scores in each of the six broad areas of standards that go into a final accreditation judgment, was formulated last fall and scheduled for use as a reporting tool by this summer. That's when enough results would be stockpiled under the new accreditation routine to calculate valid averages for comparison (Oct. 2, 1995, p. 33).
About 50 summaries will be ready by the August launch of the database, said Ann Greiner, spokeswoman for the NCQA.
The final accreditation decisions of all HMOs reviewed to date will be posted in the database, to be called "Quality Compass."
As of Feb. 29, 220 health plans had received accreditation decisions, while 26 decisions were pending and another 85 reviews were scheduled.
Reports on HMOs also will contain general descriptive information about each plan that submits data, and the NCQA said it will include guidelines for consumers and healthcare purchasers to interpret the information.
The initiative is in keeping with the NCQA's stated aim "to drive accountability by making this data more accessible," Greiner said.
But it also seeks to resolve problems inherent in current methods of data reporting by health plans and information gathering by payers, which have made the process costly and the plan-by-plan results difficult to compare, Greiner said.
The NCQA will supply each plan with a computer program to submit results electronically to the database starting in April, said James Tierney, the NCQA's director of performance verification.
That will replace the typical paper-based reports, which have to be duplicated many times during distribution to payers and are more difficult to analyze than computerized data, Tierney said. The program also provides more detail on factors that affect comparisons, such as size of the eligible population being measured, and it checks for accuracy, he said.
The submission of data is voluntary, but Greiner said the benefits to health plans will stimulate participation. The database launch corresponds to the point in the enrollment cycle in which individual employers and an increasing number of consultants are regularly asking HMOs for their HEDIS data.
Many HMOs employ several staffers to do nothing but provide such information to their customers, the NCQA said.
Instead of having to respond to each request, the health plans cooperating with the database project will be able to send the computerized, standardized results only once, Tierney said.
For employers, the storage of HEDIS data in one place can head off the expense of assembling reports from individual HMOs that can cost a large employer up to $200 per plan, Greiner said. That's without the analysis also required to judge competing plans and compare performance results against an industry average, she said.
A cottage industry of consultants and vendors has sprung up to collect the HEDIS information and provide the analysis.
Information in the database will be sold in CD-ROM format to enable comparisons by performance measure, geographic region and any other combination that helps purchasers and consumers make decisions on health plans, Tierney said.
The aggregation of all submitted electronic data also will help the NCQA produce industry averages and benchmarks to put HEDIS results in perspective, he said.
Information from the database will be available in printed form as well.
The prices charged by the NCQA start at $500 for printed reports on up to 25 health plans. The same information on CD-ROM will cost $800.
Customers who buy the whole package of more than 200 health plans will be charged $2,000 for print and $3,200 for CD-ROM. That price includes one year's worth of updates as more data comes in, Greiner said
For lower numbers of reports, the NCQA will impose an extra charge for updates.
A full printed report of all the plans will be made available for a fee to public libraries and academic institutions, Greiner said.
Information on a selected set of national and regional benchmarks will be posted on the NCQA's World Wide Web site on the Internet. The address is http: www.ncqa.org.
The NCQA said it has plans to add standardized member-satisfaction data as it becomes more available. Eventually, users will have direct access to the database and be able to query it for targeted reports and analysis, the NCQA said.
The database project's development is being supported by a loan of more than $1 million from the Commonwealth Foundation and by a small grant from pharmaceutical company SmithKline Beecham, Greiner said.
The National Committee for Quality Assurance is assembling performance-measurement results on the nation's HMOs for a database it's creating. The information will be sold according to the number of HMO reports requested and the format of the data.
No. of HMOs Printed CD-ROM
Up to 25 $500 $800
26 to 100 1,000 1,600
101 to 200 1,500 2,400
201 or more 2,000 3,200
Source: National Committee for Quality Assurance