also requesting information on health plans to help them make their health care purchasing decisions. Because accreditation standards do not directly measure quality, however, many purchasers use a combination of accreditation and an analysis of performance indicators, including outcomes. Performance indicators may not be comparable. According to a recent survey of 384 U.S. employers conducted by Watson Wyatt, a benefits consulting organization, and WBGH, 60 percent of large corporations consider accreditation status by the National Committee for Quality Assurance (NCQA) when deciding to purchase health insurance from an HMO. The clinical care measures continue to focus on providers’ actions, however, rather than outcomes. While NCQA was developing new HEDIS measures, a large group of corporate purchasers and HCFA established the Foundation for Accountability (FAcct) to develop standardized outcome measures. HCFA’s Quality Assessment Methods for Medicare Risk Contract HMOs

Like other large corporate purchasers, HCFA uses an inspection process and analysis of performance indicators to evaluate the quality of care provided to Medicare beneficiaries in risk contract HMOs. We concluded that HCFA’s HMO Qualification Program is inadequate to ensure that Medicare HMOs comply with standards for ensuring quality of care. Although HCFA collects performance information that could be useful to beneficiaries, it does not routinely make such information available to them nor does it have immediate plans to do so. Medicare: Enhancing Health Care Quality Assurance (GAO/T-HEHS-95-224, July 27, 1995).
Why GAO Did This Study

GAO discussed the Health Care Financing Administration's (HCFA) efforts to provide health care quality information to Medicare beneficiaries joining health maintenance organizations (HMO).

What GAO Found

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.