NCQA REPORT CARD ANGERS HMO GROUP

A brouhaha has broken out between the National Committee for Quality Assurance, the nation's main managed care accrediting body, and the Illinois Assn. of HMOs over the release of a preliminary "report card" on specific Illinois health maintenance organizations.

Labeling the controversy a "tempest in a teapot," the Washington-based NCQA maintains that its release of the information earlier this month to Business Insurance sister publications Crain's Chicago Business and Modern Healthcare was intended to serve only as a sample of its data-collection methods.

However, the Illinois Assn. of HMOs is blasting NCQA for disseminating an incomplete picture of HMO performance and ignoring a request to withhold the information from the press.

IAHMO issued a "member alert" Nov. 11, warning the HMOs named in the survey of NCQA officials' intention to announce the preliminary data. "Seeking press with regard to this material would not be appropriate," the memo to members said.

Robert K. Burger, executive director of Chicago-based IAHMO, said, "To represent this (data) as the final story is misleading."

The NCQA report card, which was clearly described as a prototype, rates eight HMO plans in Illinois, two in Wisconsin and one based in St. Louis that does business in Illinois. The Illinois-based plans are Aetna Health Plan, American HealthCare Providers, Blue Choice, CIGNA HealthCare of Illinois, Humana HealthCare Plans, HMO Illinois, PersonalCare Insurance of Illinois and Rush Prudential Health Plans.

Although NCQA normally rates health plans on 71 criteria, the committee based its report card comparisons on five: the percentage of adult members who had a preventive care or other visit to a provider in the past three years, the percentage of children who received all recommended doses of vaccines by age 2, the percentage of women who received first-trimester prenatal care, and the percentages of women who had breast cancer and cervical cancer screening.

For each criterion, percentages are listed for each HMO, where available, and a regional average is provided. The report card also provides summary results for each criterion that indicate whether the HMO's score is below the regional average, at the regional average or higher than the regional average.

The Illinois plans slightly underperformed national and regional averages in four of the categories.

In the fifth, prenatal care, the Illinois plans overall outperformed national norms.

NCQA President Margaret E. O'Kane described the report card as a "prototype."

"It is routine for us to share this kind of information with the press," she said.