February 8, 2005

NCQA Wins 3-Year Contract to Review
Massachusetts HMO, PPO Plans

Public-private partnership makes rigorous safety review efficient, constructive; Massachusetts is home to six of nation's top 10 commercial health plans

WASHINGTON-The Massachusetts Division of Insurance has awarded the National Committee for Quality Assurance (NCQA) a 3-year contract to review Massachusetts health maintenance organizations (HMOs) and preferred provider organizations (PPOs) against rigorous safety and quality of care standards. NCQA has been under contract with Massachusetts to review health plans since 2001; during that period, many Massachusetts health plans have been identified as quality standouts. Six Massachusetts plans were named to NCQA's national Top Ten list in September (see attached list).

"NCQA has been an invaluable partner in our efforts to ensure that our health plans meet state requirements so that Massachusetts residents get the best possible care. We anticipate that this cooperative accreditation process will continue to yield comprehensive and positive results over the next three years," said Nancy Schwartz, Director of the Bureau of Managed Care within the Massachusetts Division of Insurance.

"Massachusetts provides a good example of how the oversight process can be both efficient and rigorous," said Richard Sorian, NCQA Vice President of Public Policy. "The Commonwealth requires plans to meet certain quality standards. NCQA Accreditation recognizes and rewards plans that achieve excellence. Both strategies ensure safety and quality, and this partnership shows that they work well together."

Since many of the state's HMOs and PPOs already hold some form of NCQA Accreditation, the arrangement allows for some significant efficiencies - where the state and NCQA's requirements overlap, accredited plans may be given credit for having previously met certain requirements, thus streamlining the review process. Eleven HMOs and one PPO operating in Massachusetts currently hold NCQA Accreditation. All of those plans hold the highest level of accreditation possible.

NCQA's Accreditation program is recognized by 32 states that similarly deem NCQA-Accredited plans as having satisfied state licensure requirements. In addition, many of the nation's largest employers require health plans with which they contract to be NCQA-Accredited.

NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. NCQA provides health care quality information free of charge through the Web and media in order to help consumers, employers and others make more informed health care choices.

# # #

Massachusetts Health Plans Listed Among the Top 10
Nationwide in HEDIS® Effectiveness of Care Measures
 
Blue Cross and Blue Shield of Massachusetts
 
Fallon Community Health Plan
 
Harvard Pilgrim Health Care of New England
 
Harvard Pilgrim Health Care
 
Health New England
 
Tufts Health Plan