NCQA to Require Quality Measurement, Improvement of All Health Plans

February 15, 2007

NCQA to Require Quality Measurement, Improvement of All Health Plans

Changes Will Allow Consumers to Compare Performance of Different Plans

WASHINGTON — In a bid to dramatically improve health care quality in the U.S., all health plans seeking accreditation from the National Committee for Quality Assurance (NCQA) would be required to report on the quality of care delivered to patients under proposed requirements issued today. Under the new program, NCQA will evaluate preferred provider organizations (PPOs) on the same set of standards, clinical measures and patient experience ratings on which NCQA has evaluated health maintenance organizations (HMOs) and point-of-service (POS) plans. NCQA aims to allow consumers, purchasers, and others to make reliable, objective comparisons among different types of health plans.

"Today's confusing alphabet soup of plan types and names often distracts from what people really need to know," said Margaret E. O’Kane, NCQA President. "It doesn't matter what a plan calls itself, what matters to patients is how well they perform."

The need to improve health care quality has never been greater. Despite spending nearly twice as much on health care as other industrialized nations, Americans experience, by many measures, similar or worse health outcomes. NCQA estimates that as many as 81,000 Americans die each year because they do not receive the right care at the right time.

Under the standards proposed today, PPOs seeking NCQA Accreditation would be required to report clinical quality results using NCQA’s Health Plan Employer Data and Information Set (HEDIS®), the most widely used set of health care performance measures in the country. Plans would also be required to report results from the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) which evaluates patients’ experience with care and service.

Today, nearly two-thirds of privately insured Americans – accounting for more than 150 million people – are enrolled in a PPO. In 2006, 80 PPOs voluntarily submitted HEDIS results to NCQA but most plans do not engage in such efforts. Collecting and reporting performance data will allow consumers, employers and other purchasers of health care to easily compare the performance of all plans and make the choices that best fit their needs.

The federal government has also recognized the need for wider quality reporting. Both Medicare and the Federal Employees Health Benefits Program now require PPOs to report HEDIS data. In August, President Bush issued an Executive Order directing U.S. agencies to advance an agenda of quality and price transparency in health care.

"As we explore ways to rein in costs, we need to make sure we don’t take our eye off of the ball when it comes to quality. That means having comparable, reliable quality information to inform our decisions," said Health and Human Services Secretary Michael O. Leavitt. "Our goal is a health care system where there is competition based on value — the best quality at the lowest price."

Measurement Leads to Improvement

To further tie accreditation to improved health, NCQA also proposes to increase its emphasis on HEDIS and CAHPS in its health plan accreditation programs. Currently, HEDIS and CAHPS scores represent approximately one-third of the score a health plan needs to become accredited. Beginning in 2008, that proportion would rise sharply to 50 percent.

A decade of experience has conclusively demonstrated that the collection and reporting of quality data often leads to dramatic improvement in care. For example, health plans that collect and publicly report HEDIS results have saved as many as 83,000 lives since 1999 by improving control of high blood pressure.

Consumer advocates have also been demanding more information about the quality of care delivered in the U.S. "Reporting against a common set of quality measures does more than just let consumers make informed comparisons-it can make a real difference in terms of health outcomes and quality of life," said Suzanne Delbanco, Chief Executive Officer of the Leapfrog Group, which works to improve the safety, quality and affordability of health care. "It's critical that consumers be aware of which plans measure performance and which don't."

The nation’s employers are also calling for change. "The health and well-being of our employees and their families is our most precious investment," said Hassan Azar, J.D., M.H.S.A., Ford Motor Company Manager of Healthcare Management. "Requiring all plans to report quality is a bold step forward and a boon to those of us that make contracting decisions. That’s why Ford is asking all plans that haven’t already earned NCQA Accreditation to do so as soon as possible from today forward. It’s just common sense."

Health plans have also been leading the movement toward change. A major participant in these efforts has been CIGNA, a provider of health coverage to more than 9 million Americans nationwide. "CIGNA is proud to have led the market in PPO reporting by submitting a full set of HEDIS data for 41 PPO markets in 2006," said Leslie Campbell, CIGNA Vice President for Quality Management. "We’ll do so again in 2007 as we bring our PPO plans forward for NCQA Accreditation."

NCQA’s public comment period will last from February 15 through March 30 to allow health plans, employers, consumers and other stakeholders to review the proposed changes and offer input. Final standards will be released in July of this year and take effect on July 1, 2008. Interested parties are invited to comment on the revised standards through March 30, 2007. To download a copy of the standards and submit input, visit NCQA’s Web site at http://www.ncqa.org/.

NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA is the nation’s leading developer of health care evaluation tools including health plan accreditation, physician recognition and organization certification. NCQA also is responsible for the evolution of HEDIS, the most widely used set of health care performance measures. NCQA is committed to providing health care quality information through the Web, media and data licensing agreements in order to help consumers, employers and others make more informed health choices. For more information, visit http://www.ncqa.org/.

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