The National Committee for Quality Assurance has released the first comprehensive database on some 230 HMOs, which it says brings consumers closer to comparable quality information.
But that goal is still elusive because hundreds of plans-including some of the largest of the nation's more than 600 HMOs-are unrepresented in the data.
The NCQA's "Quality Compass" reports, available on CD-ROM and on 4,000 printed pages, combine for the first time information on HMO accreditation and plans' performance in the 1995 Health Plan Employer Data and Information Set measures.
The effort cost several million dollars and took about nine months, an NCQA spokesman said. The startup was partially funded by a loan from the Commonwealth Fund, he said.
Regional HMOs of large companies such as Cigna HealthCare and Prudential Health Care Plan are well-represented because Cigna and Prudential are both strong backers of Quality Compass. Smaller plans such as Harvard Community Health Plan also provided data.
But big accredited plans, including Cypress, Calif.-based PacifiCare Health Systems, that already provide HEDIS information to employers chose not to participate. United HealthCare Corp., based in Minneapolis, has only one regional plan in the report. Humana is absent. Aetna and its new acquisition, U.S. Healthcare, are not represented. Woodland Hills, Calif.-based WellPoint Health Networks-which was denied accreditation and subsequently sued the NCQA-is also absent.
All the nation's HMOs and PPOs were invited to participate and were sent a data-submission tool free of charge, an NCQA spokesman said.
PacifiCare has adopted a "wait-and-see" position and may participate in the future, said its spokesman, Ben Singer. The HMO has "real concerns about broad-based dissemination of HEDIS information to consumers," he said. That information was designed for employers and consultants who can interpret it, he said.
With the release of the data through the media, "we're concerned that people will try to take some data and simplify it to such a degree that it won't be as relevant as they think it is," he said. The proliferation of reports about HMOs is confusing and "almost becoming faddish," he said. "We see it as a disservice."
On the other hand, employers and the NCQA say Quality Compass is aimed at simplification. "It is grossly inefficient for employers to collect this type of information on our own, and even if we do we don't have reliable national or regional information for comparison," said Suzanne Mercure, benefits administration manager at Southern California Edison.
The reports will allow employers, consultants and consumers "to compare the quality of hundreds of health plans in a way that was previously unthinkable," said NCQA President Margaret E. O'Kane.
The American Association of Health Plans said the effort demonstrates HMOs' commitment to public accountability. But because plans "have a vision of continued improvement, we think information is more useful to consumers if they can look across a number of years and chart improvement" in plans, said Susan Pisano, the AAHP's director of communications.
Quality Compass gives data for 1995 only.
"You start somewhere," Pisano said. "There definitely is a danger that the data can be misused," she said, though she noted that the NCQA provides guidelines to interpret the data.
The first caution, according to the NCQA, is "consider the data you don't have." Participating plans "invite our scrutiny," while fee-for-service plans, generally unable to collect HEDIS data, are not represented in the report. Only two PPOs provided data.
The NCQA said the reports will encourage purchasers to focus on quality as well as cost and will give plans a strong incentive to improve and compete on the basis of quality.
The report shows national averages, regional averages and the top-performing plans for the first time. The NCQA said it "will report these...figures regularly to track improvement in the managed-care industry."
For the first time, small and mid-sized companies will be able to afford comparative data about health plan quality. Previously only larger plans could afford to assemble such data. The report also will spare HMOs the blizzard of requests for information from individual employers, the NCQA said.
Quality Compass is available by calling 800-839-6487 or using the order form on the NCQA's World Wide Web site: http: www.ncqa.org.
Because the reports are too costly for most individual consumers, the NCQA expects employers, consultants and libraries to buy them.
The printed reports, divided into four regions, cost $500 each. The cost of the CD-ROM depends on the number of plans reviewed: $800 buys data on up to 25 plans; the entire database costs $3,200.