HMO-ing Government

Published on

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.

Consumer Watchdog
Consumer Watchdog
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