using HEDIS data to evaluate the managed care plans with which they contract (Hibbard et al., 1997a). In 1996, more than 330 plans—more than half of the plans in the United States, representing more than three-quarters of all commercial managed care enrollees—reported HEDIS measures on their enrollees. NCQA produces Quality Compass, a CD-ROM-based system that makes it possible for consumers to obtain comparative HEDIS ratings for HMOs in communities throughout the United States. A subset of Quality Compass measures appears on the World Wide Web. A health plan can refuse to disclose its HEDIS profile to the public. In 1997, less than half of plans (45 percent) permitted public reporting of the data (Bodenheimer, 1999).
The American Accreditation Health Care Commission, Inc./URAC (AAHC/URAC) accredits PPOs, point-of-service plans, and other open-panel plans. These plans represent a large segment of the private insurance market, yet they have relatively little in the way of a quality measurement infrastructure (Darby, 1998).
Although many indicators of quality that are relevant to purchasers are also relevant to consumers, the perspective of consumers is gaining a separate voice in several quality initiatives. The nonprofit Foundation for Accountability's (FACCT's) principal mission is to ensure that information on quality is effectively communicated to and used by consumers. FACCT has developed a quality assessment framework that uses categories designed to be descriptive of issues of concern to consumers: the basics, staying healthy, getting better, living with illness, and changing needs (www.facct.org; Lansky, 1998). FACCT has been developing new measures and selecting existing measures for use by others in assessing quality. One of the areas for which FACCT has been compiling a set of measures is breast cancer (Table 6.2). FACCT's breast cancer quality measures are the most comprehensive of any of the organizations that currently have breast cancer performance measures and include indicators of the process of care, patient satisfaction, and outcomes. These measures are currently being field-tested to determine the feasibility of their use.
Although not a formal accreditation program, The American College of Surgeons' Commission on Cancer surveys and approves hospitals, treatment centers, and other facilities according to established standards. The goal of the program is to improve the quality of patient care through multidisciplinary cancer programs that are concerned with prevention, early diagnosis, pretreatment evaluation, staging, optimal treatment, rehabilitation, surveillance, psychosocial support, and the hospice concept (http://www.facs.org). The Commission on Cancer has approved 1,500 programs, which are estimated to provide care for 80 percent of the nation's newly diagnosed patients (Carol Cook, Administrative Coordinator, American College of Surgeons, personal communication to Maria Hewitt, February, 1999).