The model for NCQA’s current Accreditation program was developed in 1990. With the significant addition of HEDIS measures in 1999 and the transition to a Web-enabled survey process in 2004, the model remains effective for employers, consumers and health plans alike. Today, over half the health plans in the nation -- covering about 75% of all health maintenance organization (HMO) enrollees -- earn NCQA Accreditation and employers, as well as federal and state agencies, rely on NCQA Accreditation in purchasing decisions and regulatory compliance.

But innovation in health care develops at a dizzying pace. Accordingly, the definition of what constitutes an “outstanding health plan” today is very different from the definition of just a few years ago. Changes in medical and information technology, the proliferation of plan types being offered, the rise of the Internet and patient expectations are rapidly transforming the system. Quality Plus introduced new standards that reflect these developments.

It's important to acknowledge innovation. The Quality Plus standards will allow NCQA to recognize innovative plans that lead the market in areas such as leveraging the Web to promote members’ self-management of chronic conditions, allowing members to track claims online, mesuring performance, rewarding doctors for high-quality care, adopting innovative disease management programs and delivering high-value health care. Public recognition of these and other important innovations will encourage others to follow suit.

Over the next few years, NCQA's current accreditation programs will evolve by organizing the programs around the functions a plan performs rather than by plan type. This new accreditation model will allow NCQA to provide more information to more people about a larger segment of the health care market.

The Development Process

NCQA began exploring a next-generation accreditation program in late 2003 with market research and internal analysis. The Quality Plus development effort accelerated in May 2004 when NCQA convened a strategic work group consisting of 18 individuals representing employers, health plans, physicians, consumers and the federal government. The group was charged with considering how the evolution of the health care system has led to fundamental changes in the roles and ranges of activities in which health plans typically engage. Moreover, the group was encouraged to think about how to promote measurement and improvement at the hospital and physician levels of the system, and how to generate information about doctors and hospitals that would be useful for consumers.

The group’s comments focused on three areas:

• Ensuring that all organizations meet basic customer service expectations
• Ensuring that all members, regardless of health status, receive appropriate care and support to promote better health
• Standardizing performance expectations of health plans and providers.

In addition to convening the work group, NCQA conducted market research with plans, employers and consumers to provide additional input into the direction of the Quality Plus effort. NCQA also continues to work with several expert panels to look into technical issues around measurement and reporting in specific areas.