NCQA expands accreditation to include PPOs

The National Committee for Quality Assurance will soon begin performance assessments of preferred provider organizations.

By Linda O. Prager, amednews staff. Sept. 18, 2000.

The National Committee for Quality Assurance last month officially launched its new accreditation program for preferred provider organizations. The accreditor, best known for its monitoring of health plans, last summer began to phase in PPO evaluations (AMNews, July 26, 1999). At that time, the process was limited to enrollee satisfaction surveys.

Now NCQA will begin full-scale surveys, assessing PPOs' performance across five areas: consumer protection mechanisms, member service, access to care, provider credentialing and oversight. PPOs also will be required to routinely conduct member satisfaction surveys.

Five organizations, covering more than 8 million individuals nationwide, already have indicated that they will undergo reviews. They include Medical Mutual of Ohio, Hawaii Medical Service Assn., Personal Choice (subsidiary of Independence Blue Cross) and Blue Cross Blue Shield of Michigan. Private Healthcare Systems PPO network, one of the nation's largest, also has indicated that it will seek NCQA certification covering its network management and utilization management functions.

It remains to be seen if PPO accreditation really will catch on. There are more than 1,000 PPOs nationwide. But to date there's only been minimal interest in other accreditation programs that have existed for years.

Employers, though, are stepping up pressure for ways to assess performance of all the options they offer as part of their health benefits packages. Officials of the organizations now seeking NCQA accreditation indicated this pressure is, at least in part, behind their decisions to seek this seal of approval.

All of this could mean more paperwork for physicians. Already they face duplicative credentialing requirements and quality data demands from health plans trying to meet their own accreditation requirements. It's likely PPOs will come knocking soon.