Researching and Reviewing HMO Health Insurance Companies
Part 2, Chapter 7: Managed-Care Plans Page 6
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In the meantime, organizations such as the National Committee for Quality Assurance (NCQA) -- an independent, not- for-profit organization -- have developed a series of criteria for the accreditation of HMOs. The NCQA is currently in the process of conducting reviews of existing HMO programs. The eventual goal is to provide consumers with additional information so that they can make educated decisions concerning HMOs.
The NCQA has already reviewed more than half of the HMOs in the United States. Such reviews focus on six different areas during the accreditation process, including quality improvement, physician credentials, members rights and responsibilities, preventive health services, utilization management, and medical records.
The NCQA also offers a "Health Plan Employer Data and Information Set" (HEDIS) that may prove helpful to consumers who are seeking information about HMOs. HEDIS is a series of standards for measuring the performance of particular managed care plans. Information on HEDIS or on accreditation for specific HMOs is available through the NCQA's Internet site or by calling the NCOA (See Appendix B).
In addition, the federal government has surveyed federal employees in terms of their satisfaction with various HMOs. That information is available to consumers and can be quite helpful, as well (See Appendix B).
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