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Accreditation of managed care health plans does not necessarily ensure high quality care or higher enrollment rates

Managed care health insurance plans can voluntarily undergo accreditation by the National Committee on Quality Assurance (NCQA). However, plans that receive such accreditation do not necessarily provide high quality care, and plans denied NCQA accreditation do not appear to suffer enrollment losses. These are the conclusions of a study supported in part by the Agency for Healthcare Research and Quality (National Research Service Award training grant T32 HS00055).

Harvard University researchers Nancy Dean Beaulieu, Ph.D., and Arnold M. Epstein, M.D., M.A., analyzed 1996 data on health plans' NCQA accreditation status, organizational characteristics, and Health Plan Employer Data and Information Set (HEDIS) scores on quality performance (mostly preventive screening measures). They then linked these data to patient-reported quality and satisfaction scores.

Fully accredited plans performed significantly better on seven of nine HEDIS measures (which ranged from childhood and adolescent immunizations and breast cancer screening to diabetic eye exams) than plans denied accreditation. However, these differences were modest. In addition, a substantial number of the plans in the bottom 10 percent of quality performance were accredited.

Accredited plans significantly outperformed nonaccredited plans on only two of the eight measures of patient-reported quality of care and overall satisfaction. Nonaccredited plans outperformed accredited plans on one measure (choice of specialist), with an overall small difference between the plans on all measures. Also, enrollment changes for plans denied accreditation were not significantly different from enrollment changes for nonaccredited plans. Changes in 1999 NCQA accreditation standards to incorporate plan performance on CAHPS® (Consumer Assessment of Health Plan Study) and HEDIS may capture more dimensions of health care quality that consumers think are important, conclude the authors.

See "National Committee on Quality Assurance health-plan accreditation: Predictors, correlates of performance, and market impact," by Drs. Beaulieu and Epstein, in the April 2002 Medical Care 40(4), pp. 325-337.

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