Articles

RSS

The National Committee for Quality Assurance (NCQA) introduced a new survey that enables preferred provider organizations to report on member satisfaction and consumer experiences using the same survey instrument as health maintenance organizations. PPOs collectively provide health coverage for 89 million Americans, according to NCQA.

The survey, the Consumer Assessment of Health Plans Study, has historically been fielded only by HMO and point-of-service plans, but NCQA's new survey protocol will enable consumers and employers to compare HMO, PPO and POS plans using the same instrument. Several large PPO plans have already committed to reporting such data in 2000. The survey will be a core component of NCQA's PPO Accreditation program, which is slated for release in draft form in early 2000. NCQA is currently seeking other PPOs to pilot the survey.

"If we want the entire health care system to improve, we need to measure and evaluate the entire health care system," said NCQA President Margaret E. O'Kane. "Accountability can't just happen at one end of the system. Introducing (the survey) to PPOs will not only help people make more informed choices, it will mean that they get better care and service as well."

NCQA-supplied, standardized information about health care quality is recognized across the country by employers and consumers as being invaluable in making health care coverage decisions, and regularly appears in report cards in national news magazines, newspapers, and state reporting initiatives.

The survey instrument for PPOs is the same instrument as the one used by HMOs; only minor modifications were made to survey protocols to facilitate the survey's application to PPOs. The survey methodology and individual survey questions remain unchanged. The survey will evaluate plans in such areas as:

• Overall rating of health plan

• Getting needed care

• Getting care quickly

• Customer service

• Claims processing

Large employers such as the federal Office of Personnel Management, Marriott International, General Motors and others, many of whom will not do business with an HMO that cannot report NCQA data, have already indicated that they will likely use the survey results from the PPOs they work with.

"We have the same information needs from a PPO that we do from a HMO," said Amy Moore, director, associate benefits fesources, Marriott International. "In either case, we want to know that we're buying quality health care, and that our associates and their families are being well served and well cared for. We also want to see how all our health plans compare to national and regional benchmarks."

The NCQA survey "is a very important part of our overall program to provide health care quality information to all of GM's employees and retirees," said Tom Cragg, manager of managed care plans, General Motors. "It is essential that we provide them with credible consumer information for all available options, including PPOs."

Leading PPOs have also committed to fielding the new survey, both as a potential marketing tool, and to aid in internal quality improvement efforts. "We have been collecting and reporting on our members' satisfaction for years and we're proud of our results," said Jeff Kamil, M.D., vice president and medical director, Wellpoint Health Plan, one of the PPOs planning to contract with an NCQA-certified vendor to field the new survey in 2000.

Empire Blue Cross Blue Shield is also among those PPOs planning to administer the new NCQA survey next year. "It's important that we use the same tool to evaluate HMO, POS and PPO plans so that we can make comparisons within and between different systems of care," said William Osheroff, M.D., medical director, Empire Blue Cross Blue Shield. "Consumers and employers need to appreciate that there are real differences between plan types so they can make informed choices. And we need to understand our strengths and weaknesses in order to focus our improvement efforts."

NCQA maintains a database of Consumer Assessment of Health Plans Study data that will make it possible to compare PPO performance against established benchmarks and averages for HMO and POS plans. To ensure that those comparisons are valid, PPOs, like HMOs, will be required to contract with an NCQA-certified vendor to administer the survey. NCQA-certified survey vendors are thoroughly trained in proper survey methodology to ensure that data collection and calculation processes are the same from one plan to the next, thus yielding the most comparable results possible.

NCQA's goals in the first year of applying CAHPS to PPOs are to lay the foundation for its forthcoming PPO Accreditation program, and to get results from a sufficient number of early adopters to more comprehensively evaluate how the survey works within the PPO community. NCQA also plans to generate industry-wide benchmarks and averages as soon as enough data are available. NCQA expects to release draft PPO Accreditation standards in January 2000.

For more information, visit NCQA's website (www.ncqa.org). To get a copy of the survey and survey protocols, contact NCQA's Publications Center at 800-839-6487.