Plans That Won't Report
Some insurers don't want to make their performance data public
Of the 684 healthcare plans examined by the National Committee for Quality Assurance for this year's rankings, 158 did not furnish performance data or would not allow the numbers to be released, automatically disqualifying them from NCQA accreditation. (They are listed at usnews.com/healthplans after the ranked plans.) "Kids with bad report cards don't want to show them to their parents," is how NCQA president Margaret O'Kane looks at it. What if a nonreporting plan is among your coverage choices? How about a plan that is unaccredited? Paul Ginsburg, president of the Center for Studying Health System Change in Washington, D.C., devotes much of his time to mulling over such issues and offered U.S. News his thoughts.
What is the bottom line on plans that won't allow NCQA to release information?
The NCQA analysis shows striking evidence that plans that report score better on these measures.
Is there a larger message in that?
There are a lot of things we expect HMOs to work to improve-for example, how well members make use of preventive services and whether doctors have the latest guidelines and are following them. The NCQA report shows the benefits of this. If I were an employer, wanting to give my employees a good plan-and let's say I know that my employees, no matter what they say, just aren't going to stay on top of things-then I will want a plan that does well in these areas.
If a plan does well across the board, what does that say to consumers?
You might decide, hey, I'd like to be in a plan that works hard for me.
How would you react if your choices included a plan that didn't report?
If I was offered an accredited plan and a nonreporting plan, I might just say, well, I don't have as many options as I would like. I would not think less of my employer. For that matter, I would not automatically take a nonreporting plan off the table. If it cost me a lot less, well, my employer is offering me a choice.
You wouldn't exclude it right away?
Look, the single most important thing to most people besides the premium is whether their doctor is in the network, and if they use specialists, whether they are in the network. That could be more important than the data. A consumer who has a lot of confidence in his doctor might figure that he doesn't need to worry whether the plan is looking out for him, because his doctor is doing that.
How can consumers sort this out?
They can first see whether a plan is accredited, which is a positive. Some aspects of health plans are relevant to everyone, such as the appeals process. Accreditation lets you know those are available. Then they need to think about which aspects of quality are most important to them. You could be a family with children who need immunization, but you may feel you don't need the plan's help-you can stay on top of that.
This story appears in the November 6, 2006 print edition of U.S. News & World Report.
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