Health Plan Quality Information:

Efforts to Report on PPO Plan Performance

HEHS-98-213R: Published: Jul 16, 1998. Publicly Released: Jul 16, 1998.

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Pursuant to a congressional request, GAO provided information on preferred provider organization (PPO) plan performance, focusing on: (1) large health care purchasers' efforts to collect and disseminate quality performance information about PPO plans; and (2) existing requirements for PPOs to demonstrate quality assurance efforts.

GAO noted that: (1) some of the largest health care purchasers in the country--the California Public Employees Retirement System (CalPERS), the federal Medicare program, and the Federal Employees Health Benefits program (FEHBP)--have collected or plan to collect and disseminate performance data from contracting health plans, including PPOs; (2) although the information requirements apply to all plans, the entities implementing the requirements recognize that not all performance indicators are appropriate for all types of plans; (3) for example, an indicator measuring the rate at which a PPO provides a specific preventive care service may not be appropriate for a PPO that does not cover that service in its benefits package; (4) other purchasers have been slower to collect quality-related information from PPOs due to difficulties in collecting clinical and administrative data needed to ensure complete and accurate assessments; (5) still other health care purchasers have chosen not to collect PPO data, believing that the broad access afforded consumers by these plans precludes the need for such an effort; (6) in addition, Georgia and accreditation agencies are now (or will be) requiring PPOs to demonstrate quality assurance activities, including a plan's ability to collect and analyze quality, performance, and satisfaction data; (7) information on whether a PPO has been certified or accredited is generally made available to the public; (8) unlike in the case of CalPERS, Medicare, and FEHBP, consumers will learn whether a health plan has met the state or accreditation agency standards, but they would not know how well the plan performs on specific quality-related measures, either on its own or in comparison with other plans; and (9) comparisons of plans on a range of performance indicators are expected to improve over time as more sophisticated measures become available.

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