November 15, 2004
NCQA AWARDED CONTRACTS TO MONITOR THE QUALITY OF MEDICARE ADVANTAGE HEALTH PLANS
Contract includes development of new HEDIS measures for older Americans
WASHINGTON- The National Committee for Quality Assurance (NCQA) announced today that the Centers for Medicare & Medicaid Services (CMS) has awarded it two contracts to continue important work NCQA has been performing for the Medicare program. This work allows CMS to monitor and publicly report on Medicare Advantage (formerly Medicare + Choice) health plan quality using NCQA’s HEDIS measures Medicare Advantage plans contract with Medicare to provide both Part A (hospital) and Part B (physician) services to enrolled beneficiaries. Currently, 4.6 million Medicare beneficiaries are enrolled in managed care plans.
“These activities will give the Medicare program a clearer picture of the care and service received by Medicare Advantage plan enrollees,” said NCQA President Margaret E. O’Kane. “That’s information they can use to help improve quality and make Medicare even stronger. CMS is a real quality leader and we’re delighted to be working with them on this worthwhile initiative.”
The first award, Implementing the HEDIS Medicare Health Outcome Survey, is a 5-year, $4.2 million contract to continue managing the administration of the Medicare Health Outcomes Survey, a large-scale survey that measures and reports on the health outcomes of Medicare Advantage plan members. The second award, HEDIS in Medicare Managed Care, is a 1-year, $1 million agreement to continue NCQA’s collection of HEDIS performance measures from Medicare Advantage plans, and to develop new performance indicators. NCQA has developed a number of measures aimed at evaluating the quality of care delivered to older adults; most recent among them are Glaucoma Screening in Older Adults and Osteoporosis Management in Women Who Had a Fracture. The HEDIS data that NCQA collects on behalf of Medicare is reported publicly in the Medicare Personal Plan Finder tool available at the medicare.gov Web site. Additionally, HEDIS information is used by CMS staff to monitor the performance of Medicare Advantage plans.
“We’re committed to both transparency and quality improvement,” said Mark McClellan, M.D., Administrator, CMS. “HEDIS and Health Outcomes Survey data will allow us to give our enrollees the information they need to make informed choices and it will allow us to identify opportunities for improvement.”
The Medicare Health Outcomes Survey gathers reliable data on the health status of Medicare Advantage plan members. The survey measures a health plan's ability to maintain the physical and mental health of its Medicare beneficiaries over a two-year period through a survey of plan membership. Under the new five-year contract, NCQA will administer and oversee the survey’s data collection, train and certify survey vendors, and provide technical support to Medicare Advantage plans that have questions about the data collection process. NCQA has been responsible for implementing the survey since its inception in 1997.
For the HEDIS in Medicare Managed Care contract, NCQA will also study and present CMS with options for measuring the performance of preferred provider organizations (PPOs). With the passage of the Medicare Prescription Drug, Improvement and Modernization Act of 2003, it is expected that the number of PPO plans available to Medicare beneficiaries will significantly increase. CMS granted NCQA deeming authority for PPOs earlier this month.
NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations, recognizes physicians and physician groups in key clinical areas and manages the evolution of HEDIS®, the tool the nation’s health plans use to measure and report on their performance. 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 care choices.
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