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Some states require accreditation
if plans serve special groups, and some employers will only
contract with plans that are accredited.
Several
national organizations review and accredit health insurance
plans and institutions. You can contact these organizations
(many are listed below)
to see if a plan you are considering, or an institution in
the plan, is accredited.
Another
approach is to ask the health insurance plan how it ensures
good medical care. Does the plan review the qualifications
of doctors before they are added to the plan? Plans are supposed
to review the care that is given by their doctors and hospitals.
How does the plan review its own services, and has it made
changes to correct problems? How does the plan resolve member
complaints? Some managed care plans survey members about their
health care experiences. Ask the plan for a report of the
survey results.
Some health
insurance plans and independent organizations are also beginning
to produce "report cards." These reports often include satisfaction
survey results and other information on quality, such as if
a plan provides preventive care (for example, shots for children
and Pap smears for women) or if the plan follows up on test
results. Report cards may also include information on how
many members stay in or leave the plan, how many of the plan's
doctors are board certified, or how long you may have to wait
for an appointment. Report cards can only give you an idea
of how a health insurance plan works and may not give a full
picture of a plan's quality. Ask plans if their activities
have been reported in report cards developed by outside groups
(business or consumer organizations).
Finally,
you can talk to current members of the health insurance plan.
Ask how they feel about their experiences, such as waiting
times for appointments, the helpfulness of medical staff,
the services offered, and the care received. If there are
programs for your particular condition, how satisfied are
the patients?
Accreditation
Joint
Commission on Accreditation of Healthcare Organizations
Evaluates
and accredits nearly 20,000 health care organizations and
programs including almost 12,000 hospitals and home care
organizations, and more than 7,000 other health care organizations
that provide long term care, behavioral health care, laboratory
and ambulatory care services. The Joint Commission also
accredits health plans, integrated delivery networks, and
other managed care entities. Visit Quality
Check on the Joint Commission’s Web site for information
on individual accredited organizations or for general information
about assessing the quality of health care organizations.
National
Committee for Quality Assurance
Search
for information about the quality of your managed care health
plan. NCQA accredits HMOs and other managed care organizations.
American
Accreditation HealthCare/Commission/URAC
Accredits
PPOs and other managed care networks. Contact for a list
of accredited organizations.
Accreditation
Association for Ambulatory Health Care
Accredits
outpatient health care settings such as ambulatory surgery
centers, radiation oncology centers, and student health
centers. Search
for accredited ambulatory organizations.
Community
Health Accreditation Program
Accredits
community, home health, and hospice programs; public health
departments; and nursing centers.
Consumer
Coalition for Quality Health Care
A national,
nonprofit organization of consumer groups advocating for
consumer protections and quality assurance programs and
policies. Contact with general questions about quality issues
or for consumer materials on managed care and activities
at the State level.
  
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