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With 20% of Americans--and 73% of corporate employees--now in managed-health-care plans, the question of the day is: Can these plans deliver top-quality medicine? To help get at the answer, employers, consumers and even organizations like the American Association of Retired Persons (AARP) lately have been clamoring for dependable managed-care ratings. Among those leading the quest are the federal Agency for Health Care Policy and Research (directed by Clifton Gaus, seen at right) and the Washington Business Group on Health (headed by Mary Jane England, below). Says England: "Unless we can measure the quality of what we are buying, health plans have the incentive to compete only on price, which can drive down quality."

The best way to measure quality is to look at how patients' long-term health is affected by the care they get. However, evaluating results, such as survival rates after heart surgery or the recurrence of cancer after treatment, is mind-bogglingly complicated. So the scientists attempting to develop measurement techniques have tended to focus on statistics that are easier to compare, such as the ratio of board-certified specialists to plan members. To date there are two major ways for consumers to check out their managed-care plans. Soon, AARP will join in with its own evaluations. Here's where to go to get help choosing a health-care plan you can trust:

--National Committee for Quality Assurance (NCQA). If you see a medallion-type seal bearing NCQA's initials, you'll know that the health-care plan has been fully accredited by this group, which was founded by a coalition of HMOs and employers. Unfortunately, a plan gets reviewed by NCQA only if it asks for the review--and then pays as much as $100,000. As a result, NCQA has evaluated just 251 of the country's 574 HMOs and a handful of other types of plans since 1991. However, local plans of some of the nation's biggest HMOs--including Kaiser Foundation, U.S. Healthcare and Prudential--are among the ones the group has accredited.

In evaluating managed-care plans, the NCQA scrutinizes equipment, personnel, patient records and complaints. Because its ratings are based on data gathered in person by experts, it is currently the best source of clinical quality information for consumers. Based on the plan's overall score, NCQA grants accreditation for three years, one year, provisionally or not at all.

So far, only 26 of the 251 plans rated (10%) have flunked accreditation. But just 38%, including Humana Health Plan in Chicago and Fallon Community Health Plan in Worcester, Mass., for example, have achieved three-year accreditation. The current accreditation status of all reviewed plans and about 50 recent summaries of accreditation reports are available free to consumers by calling 800-839-6487. You can also find them on the Internet at http://www.ncqa.org.

--Report cards from employers. Dozens of major corporations, including GTE, Southern California Edison and Xerox, and at least two states (California and Minnesota) now offer "report cards" to employees to help them choose among health-plan options. The reports include information provided by the health plan, such as the size of its physician network, patient satisfaction ratings and, increasingly, clinical quality distinctions between managed-care providers. To be credible, a report card must be audited by an objective organization such as the NCQA. Several major insurers, including Blue Cross, Cigna, Prudential and U.S. Healthcare, voluntarily submitted data on 21 local plans to the NCQA and released audited report cards last year.

--American Association of Retired Persons (AARP). Starting next year, this 33-million-member lobbying organization for Americans over 50 will offer its stamp of approval to managed-care plans that pass its scrutiny. It is now working with Health Benefits America, an independent Salt Lake City consultant, to devise valid ways of measuring clinical quality as well as financial stability, membership dropout rates and patients' satisfaction. The question is how impartial AARP will be. That's because AARP intends to accept ongoing payments from the plans it endorses. The more AARP members who join an AARP-approved plan, the higher the fee that plan will pay.