In spite of the PPO industry's dominance in the managed care market place, it has a serious identity problem. It's not well known, particularly among consumers, that the
nation's 1,000-plus PPOs (preferred provider organizations) constitute the largest sector of managed care, providing coverage for 100 million Americans, according to the National
Committee on Quality Assurance (NCQA). It's quiet giant status, however, is about to change with new quality-based accreditation guidelines coming down the pike from NCQA. The
guidelines will force PPOs to devote more marketing resources to important areas like plan performance, access to care and member services.
The NCQA, which has a strong name among employers and consumers as an HMO quality watchdog, recently announced a draft of its new accreditation program for PPOs. The program
will allow employers and consumers to draw direct quality-based comparisons between PPOs and other managed care organizations, like HMOs and POS (point of service) plans
accredited by NCQA. Using the Consumer Assessment of Health Plans Study (CAHPS)- a surveying tool used for HMOs - PPOs will be evaluated similarly in key areas like claims
processing, customer service and ease of obtaining necessary care. The NCQA is planning to make this information available to employers and consumers in 2001.
But there is already rumbling in the industry that PPOs can't be evaluated like HMOs. "The NCQA tool is appropriate but it's important that we take a responsible approach to
[PPO] quality measures that avoid apples and oranges comparisons," says Karen Greensboro, president of the American Association of Preferred Provider Organizations.
For now - perhaps because of the important distinctions between how HMOs and PPOs deliver care -the NCQA is not evaluating the clinical services of PPOs that cover preventive
care, acute care and chronic illnesses.
The burning question for marketers is whether this newest layer of accreditation will help to better define PPOs or add to the confusion of an already obscure segment of the
managed care industry. "We are considered a whistle stop on the way to an HMO. When people have PPOs, they don't really know what they have because the plans are difficult to
describe," says Greensboro, who isn't altogether convinced that NCQA ratings will achieve their intended results. The industry needs to do a better job of educating employers,
legislators and consumers about the level of choice, access and quality PPOs already deliver, says Greensboro.
Although PPOs have been measured by the American Accreditation Health Care Commission, the assessments do not have the same level of recognition as those of the NCQA.
"The NCQA's stamp of approval will help to better distinguish top-performing PPOs," says Lynn Weiman, president of Consumer Health Network, one of 30 PPOs that has committed to
reporting CAHPS data this year. The ratings will be particularly useful for consumers who tend to judge PPOs based on the size of the network and not necessarily the quality of
care. In addition, a favorable NCQA ranking will be meaningful for large employers that often want to know the level of accreditation a PPO has during the request for proposal
process.
(NCQA, Brian Schilling, 202/955-5104; AAPPO, Karen Greensboro, CHN, Lynn Weisman, 732/562-0888, ext. 205)