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Life Health > Health Insurance > Life Insurance Strategies

NCQA: Plans That Publish Grades Do Better

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Health maintenance organizations and point-of-service plans that release quality scores tend to have higher scores than other plans.

Researchers at the National Committee for Quality Assurance, Washington, have made that argument in the nonprofit group’s latest review of health plan quality.

The NCQA is one of several large groups that evaluate health plan quality, but the NCQA contends that it is unique because its “HEDIS” data set – a large set of measures of health care quality – can give consumers, employers and others hard numbers they can use to compare plans and come up with strategies for improving performance.

In the area of completeness of adolescent immunizations, for example, all commercial health plans that participate in the main performance reporting program have increased their effectiveness score to 53.7% in 2005, from 41.6% in 2003.

Plans that make their HEDIS scores available to the public reported an average adolescent immunization effectiveness score of 55.2% in 2005, compared with an average score of just 37.6% for plans that keep their HEDIS results secret, NCQA officials report.

The NCQA recently started a separate, more limited quality program for preferred provider organization plans.

Medicare Advantage PPOs will have to start publishing HEDIS results in 2007, and PPOs covering federal employees will have to report 5 HEDIS measures starting in 2008, NCQA officials say.

But NCQA officials note that they have persuaded only 80 commercial PPOs to report quality data.

“Spreading the benefits of transparency and accountability to the millions of Americans currently in the dark will require enormous political will and the concerted efforts of consumers, purchasers, health care providers and thought and policy leaders,” NCQA officials predict.


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