Medicare: Private-Sector and Federal Efforts to Assess Health Care Quality

GAO discussed the Health Care Financing Administration's (HCFA) efforts to provide health care quality information to Medicare beneficiaries joining health maintenance organizations (HMO). GAO noted that: (1) corporate purchasers use accreditation and performance measurement monitoring to ensure that HMO furnish quality health care; (2) HCFA is starting to use similar methods to ensure HMO quality; (3) while the use of performance measurement indicators has become popular, such indicators may not be reliable or comparable, and may not be valid measures of quality; (4) 60 percent of large corporations consider HMO accreditation status by the National Committee for Quality Assurance (NCQA), before contracting with HMO; (5) NCQA developed a set of standardized information on HMO focusing on provider actions, rather than patient care outcomes; (6) NCQA recently released in draft form a set of measures based on patient care outcomes; (7) HCFA has joined with a group of corporate purchasers to develop another set of standardized outcome measures; (8) HCFA uses a qualification review program similar to accreditation, along with peer review, to assess health care organizations' quality; and (9) HCFA does not routinely make quality assessment information available to Medicare beneficiaries.