Reports will show how health plans stack up

If you thought the only thing you had to worry about was how to receive accreditation from the National Committee for Quality Assurance (NCQA), or score well on its health plan report cards, you probably haven’t heard about two big health plan assessments currently under way.

IPRO, a health care quality improvement organization in Lake Success, NY, will issue a report for consumers late this year on the performance of roughly 300 health maintenance organizations (HMOs) participating in Medicare programs.

The HMO quality report will assess the performance of managed Medicare plans using HEDIS 3.0 (Health Plan Employer Data and Information Set) measures established by the NCQA. IPRO received a federal contract to prepare the report, which is designed to help Medicare beneficiaries and their families select a managed care plan.

HEDIS 3.0 measures that apply to Medicare enrollees include:

• breast cancer screening;

• cardiac catheterization;

• coronary artery bypass graft;

• beta-blocker treatment after heart attack;

• frequency of angioplasty;

• prostatectomy;

• hysterectomy;

• eye exams for diabetics;

• follow-up after inpatient mental health treatment;

• cholecystetectomy;

• reduction of femur fractures;

• total hip replacement;

• total knee replacement;

• partial excision of large intestine;

• carotid endarterectomy.