PPOs face more quality measures

September 1, 2007

SACRAMENTO-California's six largest preferred provider organizations (PPOs) have agreed to initiate quality-of-care measures to create a Health Insurance Report Card for the state, the first in the nation for PPOs.

SACRAMENTO-California's six largest preferred provider organizations (PPOs) have agreed to initiate quality-of-care measures to create a Health Insurance Report Card for the state, the first in the nation for PPOs.

Aetna, Blue Shield, CIGNA, HealthNet, WellPoint and United have agreed to collect data on quality of care and patient satisfaction and make this information public.

"The quality of healthcare should not be a mystery to consumers," California Insurance Commissioner Steve Poizner says. "I want to raise the bar of health quality in California. Consumers should know what they're getting when they pay their healthcare premiums."

Some of the national insurance carriers such as Aetna already took the first step in this area when they agreed to submit to NCQA review, according to Allan Baumgarten, author of annual state managed care reviews and an independent research consultant in policy, finance and local market strategies. "The PPOs are trying to respond to the interest of employers in having better comparative data about the quality of care provided within PPO networks and plans."

THE CHALLENGE AHEAD

According to Baumgarten, the challenge will be to bring standardization and comparability to entities "that by definition are very hard to pin down," he says. "HMOs will still complain-with justification-that they are subject to much more oversight and reporting requirements than PPO plans."

Baumgarten finds it interesting that the California Department of Insurance is taking on initiatives to improve collection and reporting of quality and satisfaction data. "Under the last commissioner, they generally limited involvement to consumer protection cases and pushing on the big companies-WellPoint/Anthem and United/PacifiCare-for concessions in order to get state approval for their mergers/sales," he says.

According to the American Association of PPOs, more than 158 million individuals are enrolled in a PPO program-64% of Americans with healthcare coverage receive their healthcare services through a PPO delivery system.

64% The percentage of Americans with insurance who are signed up with PPOs.

Source: American Association of PPOs

"The PPOs are trying to respond to the interest of employers in having better comparative data about the quality of care provided within PPO networks and plans." – ALLAN BAUMGARTEN