Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: FRIDAY, July 21, 1995 TAG: 9507210026
SECTION: BUSINESS PAGE: A-7 EDITION: METRO
SOURCE: Associated Press
DATELINE: RICHMOND LENGTH: Medium
Accreditation from the National Committee for Quality Assurance is an element businesses look for when picking health care plans. Accreditation measures health plans' quality improvement efforts.
Committee spokeswoman Ann Greiner said this week that the committee denied Trigon's request for accreditation for its HMO Virginia Inc. and HealthKeepers plan. She declined to say why.
Trigon spokeswoman Brooke Taylor said the problem was with the way Trigon's health maintenance organizations monitor themselves.
``It was a matter of not fitting the template,'' Taylor said.
She said Trigon was changing some procedures and would reapply for accreditation next year.
Tom Maxfield, president of Carilion Health Plans in Roanoke, declined to comment, saying he had not seen anything official about the accreditation problem, nor had he received word from Trigon. His program is a unit of Carilion Health System, which with Trigon jointly owns a health maintenance organization in the Roanoke Valley.
Maxfield described the accreditation process as ``very difficult and very vigorous.''
In granting accreditation, the committee looks at how well a health plan meets 50 standards, including whether a plan fully examines the quality of care given to members, the steps it takes to be sure members have access to care in a reasonable amount of time, and how responsive a plan is to complaints and to appeals involving denied claims.
About 13 percent of the health plans that have applied for the committee's accreditation have failed to get it. About 34 percent have won full accreditation, while about 37 percent have won a one-year accreditation for meeting most of the standards. Fourteen percent have won a provisional accreditation for meeting some of the standards. The remaining 2 percent are under review.
In Virginia, Prudential Health Care System has full accreditation, while CIGNA HealthCare of Virginia Inc. and Southern Health Services Inc. have one-year accreditations.
Staff writer Mag Poff contributed information to this story.
by CNB