The meeting was a part of a PPO quality initiative project that URAC is conducting under a grant from the Commonwealth Foundation. It isn't fair to HMOs if they have to incur the cost of reporting on quality, but PPOs don't have to report at all. Meeting participants discussed what information they believe is essential in PPO performance reporting.
Consumers know very little about PPOs or about how they operate.
Participants recommended that PPOs begin to report baseline information on structural elements of PPOs that affect patients. For example, PPOs should report information on the grievance and appeals process, on information systems, and other special programs that can improve care for the chronically ill or other patient populations. Because any health system can use the survey, responses from PPO enrollees can be compared to results from HMO enrollees. The group recommended that PPOs should report on the quality of services that influence patient experiences with the health care system. These include aspects of service such as promptness of claims payment, accuracy of paid claims, telephone response, and customer service.