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With the release of its annual State of Health Care Quality report, Washington, DC-based National Committee for Quality Assurance (NCQA) has put the payer and provider community on notice that it intends to ramp up scrutiny of cost and quality outcomes in the nation's HMOs and, increasingly, PPOs. Although Margaret E. O'Kane, president of NCQA, generally praised improvements by health plans during 2006, including expanded reporting of HEDIS® measures, she cautioned that purchasers are increasingly focused on getting more bang for their buck.