Blue Cross Gets Accreditation for Its HMO

More than a year after suing the HMO industry’s leading medical quality review organization, Blue Cross of California said Thursday that it has won accreditation from the group.

The National Committee for Quality Assurance, an industry accrediting group, granted one-year approval--the second-best rating possible--to CaliforniaCare, an HMO operated by Woodland Hills-based Blue Cross.

The approval is important because an increasing number of major employers require health plans to win accreditation. Without such approval, health plans risk losing major customers.

Earlier this week, computer giant Digital Equipment Corp. said it would require any HMO treating its employees to win full, three-year NCQA accreditation--the top rating. In so doing, Digital signaled that it was raising the quality standard for HMOs.

A Blue Cross executive said the firm narrowly missed achieving the top rating, instead getting one-year approval for its HMO. Last year, in what was a significant blow, CaliforniaCare failed the NCQA review.

Then, in a move criticized by some of its competitors, it sued the NCQA, claiming the review process was flawed and unfair. At the same time, the HMO agreed to repeat the accrediting process.

Blue Cross said a decision on whether to drop the suit is pending.

The NCQA has reviewed more than half the nation’s 600 HMOs.