Managed Care Sees Need for National Guidelines, Accreditation

BUFFALO, NY—Cancer care services vary widely among health care plans in the United States, speakers told the President’s Cancer Panel at a meeting hosted by Roswell Park Cancer Institute. Suggestions for helping standardize care included use of outside accreditation centers and adoption of national practice guidelines, although the methodology to be used to develop such guidelines remains open to debate.

“Rigorous assessment of health plans is needed to provide a way for patients to consistently compare plans in their region and understand what they are being offered,” said Cary Sennett, MD, PhD, executive vice president of the National Committee for Quality Assurance (NCQA). Dr. Sennett added that employers are demanding that plans offered to their employees be accredited and demonstrate consistent performance.

Accreditation from the NCQA is a voluntary process. About 20% of all plans surveyed by the NCQA fail to achieve accreditation, and only one-third of plans that go through the process receive the committee’s highest accreditation.

“Our accreditation process and performance measurement systems are the gold standard of evaluating health plans,” Dr. Sennett said. “The answers we compile in our accreditation process serve as the core of most national report cards and help consumers consider plans. We require ongoing evaluations and a commitment to science for plans to pass.”

NCQA research has shown a wide variety in the performance of managed care plans, including the areas of cancer prevention and screening (see Table). “We see in these numbers not only that there is a wide variation among plans, but also that the national average for life-saving methods of cancer prevention may not be at the level patients need,” Dr. Sennett said.

While the NCQA offers a national accreditation process for managed care organizations, the industry itself is working toward the development of guidelines to minimize the apparent inconsistencies in care. “This has been an area of rapid growth this decade,” said George Isham, MD, speaking for the American Association of Health Plans (AAHP). The AAHP represents more than 1,000 HMOs, preferred provider organizations and other similar managed care plans.

Managed care organizations “need to express a philosophy of care that includes a partnership between patients and physicians and provides comprehensive health care for a broad spectrum of patients,” said Dr. Isham, medical director and chief health officer for Health Partners, a Minnesota-based managed care organization.

The AAHP sees a need for guidelines that are drawn from existing scientific guidelines but also include physician input. “Most academic centers base their guidelines on science; our guidelines are derivative, based on professional guidelines or other sources,” Dr. Isham said. Such guidelines offer the opinion of local physicians in addition to experts, and may differ in some of the details from the guidelines developed by physicians at academic institutions.

A new resource for patients and physicians will be launched in December 1998—the National Guideline Clearinghouse, available on the Internet at www.guideline.com. This database of multiple guidelines will allow providers, payers, and patients to research accepted care and compare different organizations’ guidelines for specific diseases.