January 27, 2005

NCQA Issues Member Connections Standards;
Focus on Service, Self-Management

Thirty-nine plans covering 11 million have scheduled reviews under new standards

WASHINGTON — The National Committee for Quality Assurance (NCQA) has released the final standards and guidelines for Member Connections, the first content area in NCQA’s new Quality Plus program. This voluntary set of standards is designed to encourage health plans to adopt innovative practices—such as making more information Web-accessible—that help “connect” members with important information about their health, resources provided by their health plan, their care options and even the costs of different drugs. The standards also assess how effectively an organization helps members understand benefits, self-manage certain medical conditions and check the status of their claims.

“As health plans advance, it will become critical for them to leverage technology to educate their members and provide them the tools they need to make good decisions,” said Phyllis Torda, NCQA Vice President for Product Development. “The leaders in the field are doing that today. We expect that these standards will encourage others to do the same. It’s clear that employers and consumers are looking for health plans that can deliver that extra level of service.”

Employers were instrumental in developing this first area of the Quality Plus program. Many have expressed strong support for the new standards. “Quality Plus directly addresses the issues that matter to purchasers and consumers. Understanding their benefits, being able to identify the best doctors and safe, high quality hospitals, tools to help make decisions about their treatment options—these are the things that matter to employers and employees alike,” said Helen Darling, president of the National Business Group on Health. “We commend the plans that have come forward for review.”

Earlier this month, NCQA released the names of 39 HMOs and PPOs that have agreed to be reviewed under the Member Connections standards beginning in July. The plans collectively cover over 11 million members.

Among the health plans already scheduled for review under the new standards is Medical Mutual of Ohio, which is bringing forward both its HMO and PPO plans. "Medical Mutual of Ohio is committed to providing ready access—by Web, by phone or in person—to the information our members need in order to make informed health care decisions,” said Paula Sauer, Vice President, Care Management, Medical Mutual of Ohio. “That’s what our employer groups are asking for—and what the Member Connections standards assess. We're looking forward to our survey.”

UnitedHealthcare brought forward six plans for review under the new standards. "People everywhere, regardless of the plan they're in, are being asked to think more carefully and make more decisions about their health care," said Lewis G. Sandy, MD, Executive Vice President, Operations, UnitedHealthcare. "To make the right choices, they need reliable resources for information and decision-making support. The Member Connections standards describe what health plans can do to provide those resources. We're proud to be among the first plans to be surveyed."

The Member Connections standards are the first content area in NCQA’s Quality Plus program, a voluntary component of NCQA’s Accreditation programs for HMOs, PPOs and point-of-service plans. Standards for two additional Quality Plus content areas, Physician and Hospital Quality and Health Improvement, will be released for public comment in March and finalized this summer. Physican and Hospital Quality standards will look at issues such as how plans measure the quality and efficiency of doctors and hospitals, how plans make this information available to their members and whether plans use this information to provide financial incentives for high quality care. Health Improvement standards will evaluate how plans support wellness and how effectively plans manage certain chronic conditions. Quality Plus standards are designed to provide consumers and employers with an added basis for comparing different types of plans, including HMOs, PPOs and consumer-directed health plans (CDHPs).

The Standards and Guidelines for Member Connections are available at no cost through NCQA’s Web site at http://www.ncqa.org/publications. For more information about the new Member Connections standards or the Quality Plus program, contact NCQA Customer Support at (888) 275-7585 between 8:30 and 5:30 Eastern.

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 performance measurement tool used by more than 90 percent of the nation’s health plans. NCQA is committed to providing health care quality information through the Web and the media in order to help consumers, employers and others make more informed health care choices.