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A brief look at the NCQA's comparison of health plan performance.
ON 1 OCTOBER 1997 the National Committee for Quality Assurance (NCQA) released comparative information on the quality of care provided by a majority of the capitated health care systems in the United States. The release of the Quality Compass 1997 database was a major step in national efforts to make standardized, planspecific performance information available to individuals and groups in the marketplace.
The Quality Compass 1997 data set includes information on patient care delivered in 1996 by commercial health plans that collectively cover more than thirty-seven million Americans. The data offer an unprecedented opportunity to examine and compare performance across the managed health care industry and to hold health care systems publicly accountable for the quality of services provided.
DATA COLLECTION
The NCQA's Health Plan Employer Data and Information Set (HEDIS) 3.0, released in January 1997, established standardized specifications and implementation guidelines for seventy-one measures related to clinical performance, procedure utilization, and patients experiences and satisfaction with care. Health plans used an electronic data submission tool provided by the NCQA to voluntarily submit information following HEDIS guidelines. The data were entered into the NCQA's database. Each health plan then reviewed its own data set and verified its accuracy. Approximately 20 percent of submitted plans reported undergoing external audits of their data prior to submission.
We report information on thirteen HEDIS measures-eight clinical and five patient experience/satisfaction measures-that convey the initial findings of the NCQA's ongoing analysis of managed care quality. These results illustrate many key issues that are currently being debated regarding managed care quality (for example, pregnancy care and care for the chronically ill). In addition, HEDIS measures serve as important indicators of the managed care industry's overall performance.
OVERALL RESULTS
PLAN CHARACTERISTICS. The 339 health plans that submitted information to the NCQA were similar to those described in InterStudy's Competitive Edge 6.2 report, a summary of information on commercial managed care plans.1 The health plans were comparable to all plans with respect to model type, regional location, and tax status (Exhibit 1).2
CLINICAL MEASURES. In general, HEDIS measures apply to persons who have been continuously enrolled for a specified time period (usually one year), have an assigned primary care provider, and...