For several years, the Medical Quality Commission has worked quietly to improve care at prepaid medical groups on the West Coast.
Now, the little-known accreditation group hopes to expand its role as capitation spreads throughout the country.
That expansion could be aided by the anticipated merger of its parent, the Unified Medical Group Association, which represents about 90 prepaid medical groups, with the American Group Practice Association, which has 250 large medical groups nationwide. The associations expect to vote on the merger by this summer.
Unlike other accrediting bodies, the Medical Quality Commission focuses exclusively on medical groups that do prepaid care (See box).
The commission actively champions prepaid medicine, or capitation. Chief Executive Officer Alan Zwerner, M.D., calls it "the magic" that creates better care at lower cost.
Zwerner distinguishes capitation from "micro-managed care, carved-out care, disintegrated care, 1-800-NURSE, PPOs-those things we feel are intrusive, counterproductive and make physicians and patients unhappy."
The commission started in the 1980s as a function of the UMGA and became a separate corporation in 1991. Its board is appointed by the UMGA, which is the sole corporate shareholder.
The commission does education and research and recently embarked on collaborative projects to solve capitation problems. Last year, when legislation was passed in California requiring health plans to define qualifications for primary-care physicians, the commission united representatives of doctors and health plans to agree on a definition. It also helped formulate a single physician credentialing application.
Its bread-and-butter, accreditation, is increasingly recognized as a badge of quality by employers and health plans, Zwerner said.
Twenty-six groups have been accredited-86% of those surveyed. Seven were accredited in 1995. Recently, the commission developed an accreditation program for independent practice associations that work under capitation.
Last year, LaSalle Clinic of Menasha, Wis., became the first group outside California and Oregon to receive accreditation.
LaSalle's medical director, David Hathaway, M.D., said the process gave him leverage to improve utilization practices and other operations in the group, which has 185 physicians and other providers. He thinks accreditation will become more important in marketing. It already is in California. Beaver Medical Group in Redlands, with about 120 physicians, touted its accreditation in advertising. The group also hopes its quality standards bolster its esteem among HMOs.
Both prepaid medical groups and HMOs would like MQC accreditation to be accepted in place of site visits and credentialing by HMOs. That would expedite the process for everyone. But the National Committee for Quality Assurance, which accredits health plans, will not allow HMOs to delegate oversite to a third party.
"We have been trying and the plans have been trying on our behalf to get the NCQA to understand-specifically in the West where you have network-area HMOs and you have so much delegated-that the oversight needs to be better interpreted and streamlined," said MQC Chief Operating Officer Lori Bloomfield.
The commission has fostered ties with employers and HMOs, some of which provide funding. Officials of Southern California Edison Co., Rockwell Corp. and General Electric Co. sit on its board, as well as executives of HMOs, including Blue Cross of California and Health Systems International's Health Net.
Last year, the MQC received a $2.5 million grant from Blue Cross of California for its work in education and quality improvement programs. Also, the Pacific Business Group on Health is working with the commission on an outcomes and patient-satisfaction study.
The UMGA had planned to require accreditation for all its members, but dropped the idea. It will require as of July that its board members be from groups accredited in managed care.
If the AGPA and the UMGA were to merge, the merged entity would decide whether to require accreditation. AGPA Executive Vice President Don Fisher said the new group probably wouldn't require it, although he's impressed with the commission's vision of accreditation as a learning process.
"I don't think a national organization like AGPA ought to be in the business of telling their members which accrediting body meets their needs," Fisher said.
Zwerner hopes the anticipated merger will encourage groups outside California and Oregon to seek accreditation. "I think if what we're doing is valuable, people will seek it out. Whether or not some trade organization requires it for representation on the board is not going to (determine) success," he said.