In a move that significantly increases the number of consumers with HMO quality information, the federal employees healthcare program will give accreditation data to millions of enrollees to help them choose health plans for 1997.
More than 9 million employees, retirees and their dependents who are part of the Federal Employees Health Benefits Program, or FEHBP, will receive information on how the National Committee for Quality Assurance rated health plans.
Beneficiaries will receive the NCQA's accreditation data in the FEHB Guide, which includes information on health plans that employees use during the program's yearly enrollment period. The enrollment period begins this week and ends Dec. 9.
As the largest healthcare purchaser in the world, the FEHBP potentially could spur quality improvement as the program's 388 plans compete for federal employees' premiums on the basis of whether or not the NCQA considers them high-quality operations.
"We hope it will drive choice based on quality, not just on price," said NCQA spokeswoman Ann Greiner.
"Providing this information will change the decisions that the employees make," said Donald White, spokesman for the American Association of Health Plans.
White added, however, that his association hopes the White House Office of Personnel Management, which runs the FEHBP, in the future will include accreditation status given to health plans from other groups, such as the Joint Commission on Accreditation of Healthcare Organizations.
The first inclusion of the NCQA ratings follows by a year the introduction of consumer satisfaction data to the FEHB guide.
The NCQA accredits managed-care plans for one year or three years based on their ability to meet standards of quality improvement, physician credentialing, enrollees' rights, preventive services, utilization management and medical records.
A three-year, or full, accreditation is given to plans with excellent continuous quality-improvement programs that meet all the NCQA's standards in other areas.
One-year accreditation is given to plans that have well-established quality-improvement programs and meet most standards. Provisional accreditation is given for one year to plans with adequate quality-improvement programs that meet some standards.
Plans given both one-year and provisional accreditation can receive a higher accreditation status after a year when they demonstrate improvement.
Of the 243 plans the NCQA had accredited as of Sept. 30, 102, or 42%, were granted full accreditation. Another 89, or 37%, received one-year accreditation, and 25, or 10%, received provisional accreditation. The NCQA denied accreditation to 25 others, and two were under review.
There are more than 600 HMOs in the United States.