August 1, 2005

New NCQA Standards Promote Wellness, Preventions; 56 Health Plans Schedule Surveys

Care Management and Health Improvement standards
are part of voluntary Quality Plus program

The National Committee for Quality Assurance (NCQA) today announced that 56 health plans (see attached list) have signed on as “early adopters” of its new Care Management and Health Improvement standards. The early adopters will all be surveyed against the standards, which focus on wellness and prevention, disease management and complex case management, over the next several months. The new standards are part of NCQA’s Quality Plus program, which allows NCQA-Accredited plans to pursue additional distinction in selected areas by meeting tough new standards even before they become mandatory.

“In five years, most health plans will engage in the kinds of activities we’re looking for with these new standards,” said NCQA President Margaret E. O’Kane. “But if you’re selecting a health plan tomorrow, you really want to know which plans are taking steps now to prevent and manage chronic conditions. It’s terrific that so many plans have come forward as we launch this program.”

The Care Management and Health Improvement standards will distinguish health plans that excel at engaging members in wellness and prevention. Such plans might, for instance, identify and recruit smokers into smoking-cessation programs or send out reminders to members who may have missed routine screenings.
The new standards also look at how well an organization uses various information sources to identify and manage members with chronic illnesses or complex conditions. Patients with complex or multiple illnesses often require particularly individualized or intensive treatment. The standards ask not only whether programs— known as “case management” programs—exist, but also how effectively members who might benefit are referred to the programs. The standards also assess how plans measure the impact of case management using, for example, rates of hospital readmissions and emergency room visits.

“Health plans that meet NCQA’s new standards give their members with chronic illness the resources they need to effectively manage their conditions,” said Helen Darling, President, National Business Group on Health. “Improved care management of chronic illness results in fewer sick days, fewer hospital stays, lower medical costs and, most importantly, improved productivity and quality of life. Employers will take notice of this when they make their contracting decisions.”

Consumer groups also lauded the new standards. “Complex illnesses place a high burden on spouses caring for loved ones, parents caring for children, and children caring for their parents,” said Ellen Stovall, President of the National Coalition for Cancer Survivorship. “Plans that take a team approach through case management programs give families invaluable support when a loved one has a complex condition.”

Health plans participating in the program noted their emphasis on prevention. “Regular wellness and prevention visits figure significantly in a health plan’s promise to its members,” said Laura Bird Long, M.D., M.P.H., Vice President of Health Services and Chief Medical Officer, BlueChoice HealthPlan. “We’re committed to acting in partnership with our physicians and customers to help all of our members get and stay healthy.”

The new standards are the second NCQA has released for its Quality Plus program. The first set, Member Connections, was published in January; those standards look at how health plans use their Web sites to provide members with health, pharmacy and claims information. The Member Connections standards were also well received—40 plans representing over 11.5 million members have already committed to a Member Connections survey.

The Quality Plus program will help NCQA transition, over the next several years, to a more flexible set of evaluative programs that will apply to the broader range of health plan types in the marketplace.

Surveys against the Care Management and Health Improvement standards are scheduled to begin on October 1; the first group of decisions will be announced in the first half of 2006. For more information about the standards or related educational opportunities, visit NCQA’s Web site at www.ncqa.org.

NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations 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.