March 2, 2005           

NCQA Promotes Physician and Hospital Measurement,
Care Management with New Draft Requirements

Voluntary “Quality Plus” standards released for public comment today; Comments due by April 18

WASHINGTON— The National Committee for Quality Assurance (NCQA) today released for public comment draft standards for the second and third content areas of Quality Plus—a new voluntary program designed to identify organizations that adopt innovative practices which promote quality care. The draft standards emphasize wellness and prevention, management of chronic illnesses, complex case management, physician and hospital performance measurement and other promising strategies for improving health care quality. Comments on the Care Management and Health Improvement and Physician and Hospital Quality standards are due by April 18.

“These standards will help people identify those plans that are on the leading edge in terms of wellness, complex care, measurement and access to information,” said NCQA President Margaret E. O’Kane. “Even if you’ve never heard of these things, as a member enrolled in a plan that is doing them well, you’ll notice a difference.”    

Physician and Hospital Quality: Provider-Level Measurement

Plans seeking distinction in the Physician and Hospital Quality content area will need to demonstrate that they measure the quality of care delivered by their network doctors and hospitals. The standards also require that organizations use those results to improve the quality of patient care—by publicly reporting results, providing information about provider quality in print and online directories and by setting quality goals or designing pay-for-performance (P4P) programs to reward providers that meet such quality goals.

Pay-for-performance has gained enormous traction in health care over the past two years – more than 80 demonstration projects are underway nationwide. Both the Centers for Medicare & Medicaid Services and the Institute of Medicine have called for health care payment systems that better reward quality.  Employer groups, health plans and state governments are among other P4P program sponsors. The standards are specifically designed to encourage collaborative efforts to produce reformed payment systems that reward quality, such as the Integrated Healthcare Association’s P4P effort in California and the Community Measurement Collaborative in Minnesota . Performance measures based on medical evidence, a development process that includes provider input, and the reporting of detailed information to the public are hallmarks of both programs. The Physician and Hospital Quality standards emphasize all these methods.

Health care purchasers expressed strong support for the standards. “Employers want to reward health plans and providers who are willing to be pacesetters for quality, high performance and accountability,” said Helen Darling, President of the National Business Group on Health. “If employers see that a plan meets Quality Plus standards, they’ll already know that it’s gone the extra mile to deliver high-quality care and provide robust information about the quality of their providers. That makes a real difference when it’s time to choose a health plan.”

Organized labor also praised the new standards. “The data that plans collect on provider-level information represent a real opportunity for plans to help their members make better choices,” said Steve Sleigh, Director of Strategic Resources for the International Association of Machinists. “We applaud the new standards and look forward to their rapid adoption by health plans.”   

Care Management and Health Improvement: Promoting Wellness, Prevention

The Care Management and Health Improvement standards will distinguish health plans that excel at promoting wellness and prevention. The standards identify whether plans offer services such as well-child and well-adolescent visits. They also look at how well an organization uses available data to identify and manage members with chronic conditions. As these standards build upon current accreditation standards and HEDIS measures exclusive to managed care organizations (MCOs), only MCOs can achieve distinction in this content area.

Some patients with complex or multiple illnesses require particularly individualized or intensive treatment. The standards ask not only whether programs— known as “case management” programs—exist, but also how effectively members are referred to the programs. The standards also assess how plans measure the impact of case management on such aspects of care as hospital readmission rates and emergency room visits.

The measures were developed with the input of stakeholders from across the health care system, including purchasers, consumer groups, health plans and physicians. “Quality Plus is designed to help the industry promote the best quality improvement practices around,” said Richard Baron, M.D., a Director of the American Board of Internal Medicine. “Just as important, they encourage health plans and doctors to work together to adopt these strategies – collaboration is the real key to driving improvement and reducing the waste of redundancy.”

The Quality Plus program represents NCQA’s first steps to transition over the next several years to a more flexible set of evaluative programs that will apply to a wider range of organizations, including PPOs and consumer-directed health plans.  The first content area, Member Connections, was released in January and looks at how plans use their Web sites to provide members with health, pharmacy and claims information. The standards have been well received—40 plans representing over 11.5 million members have already committed to scheduling a survey.  

Changes to Accreditation Standards Posted for Public Comment

In addition to the new Quality Plus content areas, several changes to NCQA Accreditation standards proposed to take effect in 2006 were released for public comment today. Notable among the changes are the incorporation of new HEDIS® measures into the accreditation program and a new requirement that organizations notify affected members within 15 calendar days if a prescription drug has been withdrawn from the market.

Comments Due April 18

Comments on the draft Quality Plus content areas and new Accreditation standards are due by April 18. To download the draft standards for public comment—or to submit a comment—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 offers recognition programs for physicians and physician groups.  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.