Committee reduces HMO's accreditation FreeState Health Plan found by panel to be in 'partial compliance' NTC

October 18, 1997|By M. William Salganik | M. William Salganik,SUN STAFF

FreeState Health Plan, an HMO operated by Blue Cross Blue Shield of Maryland, has been reduced from three-year to one-year accreditation by the National Committee for Quality Assurance.

NCQA found FreeState in "partial compliance" -- meaning it "met about half of the requirements" -- in "utilization management," which includes "how fair, consistent and prompt the plan is in making decisions" and "how the plan ensures [that] the approval process does not cause unnecessary problems for members or providers."

The NCQA's summary report shows FreeState in "full compliance" with medical-records standards and in "significant compliance" with standards in quality improvement, members' rights, physician qualifications and preventive health services. The FreeState evaluation also covers CareFirst HMO, Medi-CareFirst and FreeState Medicaid.

Dr. Daniel Winn, medical director for the division of managed care at Blue Cross Blue Shield of Maryland, said FreeState was one of the first HMOs in the country to undergo review under new, tougher NCQA standards.

Winn said he thought that in some cases FreeState was performing well but not documenting everything thoroughly. He said FreeState needs "more complete capture of the services provided to our members.

Margaret O'Kane, president of NCQA, a Washington-based non-profit that runs the voluntary accreditation program, said HMOs must show improvement on some measures to retain full accreditation.

An NCQA spokesman, Barry Scholl, said the agency did not track how many HMOs were moved from three-year to one-year accreditation. Overall, he said, 56 percent of the HMOs that have been reviewed have three-year approval, 34 percent have one year, 4 percent have provisional accreditation and 5 percent had approval denied.

Pub Date: 10/18/97

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