Health Care Threatened by Lack of Accountability

According to NCQA in its brief of the findings, people who received health benefits from health plans that measure and report performance data more often received appropriate preventive care and treatment for chronic illness.

Historically, only Health Maintenance Organizations (HMOs) and Point of Service (POS) plans have been held accountable for their quality of care by employers, regulators, and the media, NCQA points out. Many employers require these plans to receive accreditation from NCQA, and many states and the Centers for Medicare & Medicaid Services require annual reporting of clinical quality information.

The problem, according to NCQA, is that many employers are switching to Preferred Provider Organizations (PPOs) and High Deductible Health Plans (HDHPs) in order to control costs and to answer consumer complaints about limited access to providers. These plans have not been held to the same scrutiny for measuring and reporting quality.

In addition, PPOs and HDHPs require consumers to shoulder more of the financial and decisionmaking responsibilities of their own health care, and they’re not getting enough information.

For continued improvement in health care quality, NCQA believes that regulators, consumers, and employers should require all health plans to measure and report on care quality, and reward them for it. The committee also suggests that consumers should be provided information on which hospitals and health plans report on quality, and that payments to physicians, institutions, and health plans should be based on quality.

The NCQA State of Health Care Quality 2005 Facts Brief is here .