Medicare News
| For Immediate Release: | Contact: |
| Wednesday, May 14, 1997 | CMS Office of Public Affairs 202-690-6145 |
For questions about Medicare please call 1-800-MEDICARE or visit www.medicare.gov. |
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ISLAND PRO GETS HCFA CONTRACT TO EVALUATE MEDICARE HMO DATA
The Health Care Financing Administration announced today it has awarded a contract to Island Peer Review Organization, Inc. of Lake Success, N.Y., to evaluate the data that Medicare health maintenance organizations will be submitting to HCFA in June. HCFA intends to publish the results from the data later this year as a guide for consumers in choosing a Medicare managed care plan.
Island Peer Review Organization (IPRO), which monitors quality of health care for Medicare beneficiaries in New York state, will audit the validity and accuracy of the Health Plan Employer Data and Information Set, known as HEDIS 3.0. Required to be sent to HCFA by HMOs nationwide, the HEDIS 3.0 data will facilitate consumer comparisons among Medicare managed care plans. HCFA anticipates that approximately 250 plans will submit HEDIS data this year.
Currently, five million Medicare beneficiaries are enrolled in managed care organizations. By 2000, HCFA expects Medicare enrollment in managed care to rise to 12 million beneficiaries.
The audit to be conducted by IPRO will provide HCFA and HMOs with detailed information about HMO performance and help to identify how to improve data reporting. The audits will be performed at managed care plans and in IPRO's offices. The audits will be guided by a technical advisory panel comprised of representatives of HCFA, IPRO and other experts.
HEDIS 3.0 is a set of performance measures developed by the National Committee on Quality Assurance, a private accrediting organization that developed HEDIS 3.0, to assess the care provided by managed care organizations. Effective Jan. 1, 1997, HCFA is requiring Medicare HMOs to collect and report on the HEDIS 3.0 performance measures relevant to Medicare beneficiaries in managed care plans. The plans also will participate in a beneficiary satisfaction survey that will be independently administered.
The performance measures to be audited by IPRO include four quality of care categories and 11 utilization of services areas. The quality of care measures are the rates at which each plan provides:
- Female members with breast cancer screening;
- A prescription for beta blockers after a heart attack;
- Diabetics with eye examinations; and
- Appropriate follow-up after hospitalization for mental illness.
