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Life Health > Health Insurance > Life Insurance Strategies

California Persuades Major PPOs To Publish Performance Data

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Golden State regulators have persuaded 6 large preferred provider organization plans to compile the same kinds of performance reports that most large health maintenance organizations now compile.

The plans have agreed to collect data in the Healthcare Effectiveness Data and Information Set format.

The participating PPOs are units of Aetna Inc., Hartford; Blue Shield of California, San Francisco; CIGNA Corp., Philadelphia; Health Net Inc., Woodland Hills, Calif; WellPoint Inc., Indianapolis; and UnitedHealth Group Inc., Minnetonka, Minn.

The National Committee for Quality Assurance, Washington, a group that includes both employers and insurers, developed the HEDIS format for HMOs and has been trying to persuade PPOs to supply HEDIS data.

Some groups have developed PPO assessment systems that rely mainly on patient satisfaction figures and customer service measures, but the NCQA has argued that requiring PPOs to report care quality indicators could lead to improvements in care for PPO members.

HMOs typically report on indicators such as the percentage of member babies who have received the appropriate vaccinations and the percentage of older female members who have had mammograms.

California wants to use PPPO HEDIS data and data from another program, the Consumer Assessment of Healthcare Providers and Systems survey to develop a California PPO report card by 2009.


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