Publication Date: May 1st, 1999
Publication Type(s): Working Paper
Topic(s): Medicare
Author(s): Casey, M., Klingner, J.
This paper is the third in a series examining the relationship between HMO accreditation and HMOs that serve rural areas. Earlier research examined the statistical relationship between HMO accreditation and the rural proportion of an HMO’s service area population, and analyzed the implications of state HMO accreditation requirements for HMOs serving rural areas. The purpose of the current study is to explore in further depth the relationship between HMOs serving rural areas and accreditation by interviewing representatives of two groups of HMOs that serve rural areas. This study addresses the reasons the HMOs have or have not applied for accreditation; any difficulties they have had or anticipate with NCQA accreditation standards, especially in the rural portions of their service areas; and their plans regarding accreditation by NCQA and other accrediting organizations. It also explores the HMOs’ experiences collecting and reporting HEDIS data, including any difficulties they have experienced with HEDIS measures in the rural portions of their service areas.