HMO-ing Government

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Aug 03, 2004 - 03:30 PM

HMO-ing Government

by Jamie Court

The plan submitted by the Governor's California Performance Review will not streamline government, but in many cases decapitate it.

Case in point is the recommendation to allow the private accreditation agency, the National Committee For Quality Assurance (NCQA), to perform state audits of HMOs. The audits are currently conducted by the State Department of Managed Care.

NCQA was formed in 1979 by the trade associations for the managed care industry -- the American Managed Care and Review Association and the Group Health Association of America. The group was founded, in fact, to counter the federal government's attempts to monitor HMOs. The main funding source for NCQA has been HMOs, whose executives have filled its board of directors. NCQA has created its own performance measurements -- the Health Plan Employer Data and Information Set (H.E.D.I.S.).

According to former Justice Department attorney Kenneth Anderson. "The NCQA effort is in part essentially a massive public relations program orchestrated by the managed care industry in hopes of averting the establishment of a truly independent and objective mechanism... to define what quality of health care is."

Not surprisingly, HMOs -- Wellpoint, Health Net and the California Association of Health Plans -- contributed their thoughts to the recommendation. Consumer advocates were not contacted.

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