Nevadans deprived of HMO rankings

Thursday, Sept. 24, 1998 | 10:46 a.m.

The National Committee for Quality Assurance's effort to compare the nation's HMOs won't do Nevada consumers much good -- none of Nevada's HMOs participated.

Two of the largest HMOs serving Southern Nevada residents received the highest accreditation rating possible by the NCQA, a non-profit organization dedicated to assessing and reporting on the quality of managed care plans.

But they either didn't participate in a performance measurement report or told the NCQA not to release data they provided.

"They're afraid of data being used irresponsibly by the media or consumer groups," said Barry Scholl, communications director of the NCQA when asked why some HMOs don't allow information to be released. "In Nevada, there's apparently no one among the employer community demanding this information, no activist group or media outlets with loud voices asking for it."

The NCQA uses different methods to evaluate HMOs. In 1991, it began an accreditation program in which managed care organizations voluntarily turned over information and agency investigators reviewed documents and interviewed program enrollees to determine if the organizations were doing a good job.

The agency studies management quality and improvement, credentialing of physicians in the network, communication with members, preventive health services, processes for determining members' needs and maintenance of medical records.

In 1993, the NCQA developed HEDIS -- health plan employer data and information set -- a standardized performance measurement system to compare health plans. The NCQA uses the analogy that if accreditation is a car safety inspection, HEDIS is a test drive to evaluate performance.

Out of HEDIS data, the agency developed the Quality Compass, a national report card consumers could use to compare health plans. That's the report that was issued on Wednesday that local HMOs did not participate in.

Charlene Herst, a spokeswoman for Health Plan of Nevada Inc., a subsidiary of Las Vegas-based Sierra Health Services Inc., Nevada's largest health plan with nearly 180,000 members, said because the HEDIS report is relatively new, her company wanted to see how information was presented before participating.

"Before it (the report) proves that it compares apples to apples, we have declined participation in the the Quality Compass," Herst said.

She also cited additional costs of preparing data for the HEDIS report, noting the state requires national accreditation, but not performance-measuring reports. The application fee alone for the HEDIS report is about $10,000.

PacifiCare of Nevada, which offers the Secure Horizons health plan, submitted data to the NCQA for the Quality Compass report, but requested that it not be made available to the public.

"Health plan data submitted to Quality Compass is not audited and therefore reflects self-reported data," said Kayla Callas, a spokeswoman for PacifiCare. "Such data is incomparable and does not portray an accurate basis for health plan comparisons."

Callas also said PacifiCare's policy is to release HEDIS data directly to employer groups as part of the discussion of health benefits for employees.

She said PacifiCare may publicly release its results after next year's audit.

Both Health Plan of Nevada and Secure Horizons have been accredited by the NCQA. Health Plan of Nevada was the first to receive the designation with a one-year accreditation issued in June 1997. Earlier this week, the company was notified of its receiving full accreditation, the top rating, effective for a three-year period.

Secure Horizons was the first plan in Nevada to receive full accreditation, with company officers being notified of the rating in February.

Two other HMOs serving Las Vegas have not been in business in the area long enough to establish a record upon which plans could be judged.

Louisville, Ky.-based Humana Inc. and Amil International of Nevada are working toward certification.

"We don't have a history of being in Las Vegas," said Ross McLerran, a spokesman for Humana, who said the company has full accreditations for operations in Texas, Missouri and Florida. "We have only one to two years of evidence and we're in the process of getting systems and processes in place to be accredited."

"We're going to apply," said Candis Lee Englant, compliance officer for Amil in Las Vegas. "The state requires accreditation through NCQA or the Joint Commission on Accreditation of Healthcare Organizations and that's under way."

Englant said in addition to gearing up operations, new companies have to build a client base to make percentage statistics meaningful.

"If you have three women out of three getting mammograms to screen for breast cancer, that 100 percent rate would skew the results," Englant said.