About Quality Plus

Q. What is Quality Plus?  

A. Quality Plus is NCQA’s multi-year program to transition to a new, more flexible generation of measurement and accreditation programs designed with the full range of health care entities in mind—particularly newer models such as consumer-directed plans. The program will provide consumers and employers with invaluable new information about additional aspects of plan quality and performance to help guide choice.

Quality Plus was introduced as a voluntary program for plans with NCQA-Accredited commercial product lines. Plans may opt to achieve distinction in Quality Plus content areas in addition to their accreditation. Starting in July 2007, standards from two of the three voluntary areas will be a required part of accreditation.

Because accredited plans are on a three-year cycle, plans whose accreditation survey is farther out may continue to add Quality Plus as voluntary areas. The third area, Physician and Hospital Quality, remains voluntary for all plans.

Quality Plus Content Areas 

Q. What are Quality Plus “content areas?”

A. The Quality Plus program includes three content areas, with standards addressing the following questions:

Member Connections (MEM): Do members have access to interactive information? Can they track claims? How functional is the plan’s Web site? Does the plan take advantage of available technology to provide good service? Can members engage in a health risk appraisal?

Care Management and Health Improvement (CHI): Does the plan offer its members specific services based on their own unique health status? How effectively does the plan manage members with chronic conditions and complex illnesses? Does the plan work to make all its members healthier?

Physician and Hospital Quality (PHQ): Does the plan regularly measure and report on the performance of network doctors and hospitals? Does the plan disclose how it uses that data? Does the plan work with physicians and hospitals to share and seek information? Are physicians given financial rewards for delivering high-quality care? Do members have incentives to select high-quality physicians? Does the plan participate in a collaborative measurement initiative with other plans—or support physician-initiated measurement activities?

Q. What has been integrated into MCO and PPO Accreditation?

Quality Plus was introduced as a voluntary program for plans with NCQA-Accredited commercial product lines. Plans may opt to achieve distinction in Quality Plus content areas in addition to their accreditation. Starting in July 2007, standards from two of the three voluntary areas will be a required part of accreditation.

Because accredited plans are on a three-year cycle, plans whose accreditation survey is farther out may continue to add Quality Plus as voluntary areas. The third area, Physician and Hospital Quality, remains voluntary for all plans. 

Plan Eligibility  

Q. Who is eligible for distinction in Quality Plus content areas?  

A. Any managed care organization or preferred provider organization holding a current Accreditation status from NCQA is eligible to hold distinction in MEM or PHQ Quality Plus content areas at the product line (HMO, HMO/POS or PPO) level.

Additionally, any MCO or PPO undergoing an initial Accreditation survey may opt to undergo a Quality Plus survey at the same time; however, Quality Plus distinction will only be awarded if the organization is awarded an Accreditation status of “Excellent,” “Commendable,” or “Accredited.”

The Care Management and Health Improvement content area is limited to organizations that hold or are undergoing NCQA MCO Accreditation.

At this time, Quality Plus distinction is only available to commercial product lines.

Q. When can Medicare and Medicaid plans apply for Quality Plus?   

A. Effective July 1, 2007, plans may bring any product (Commercial, Medicare, Medicaid) through CHI. 

Quality Plus Applications and Surveys  

Q. How do I apply for a Quality Plus survey?  

A. Applications for for voluntary surveys are available here.  

Q. How much does a voluntary survey cost?  

A.  Pricing and payment schedules are available in the Quality Plus application. Click here to request an application online, or contact Customer Support for more information.

Q. How do I obtain the Standards and Guidelines and/or the Survey Tool for the voluntary content areas?  

A.  The Standards and Guidelines for the voluntary supplemental content areas are available by clicking here.

Q. How will Quality Plus results be reported to the public?  

A.  A plan that passes the voluntary content area is awarded distinction with a special icon on NCQA's Health Plan Report Card. In addition, plans that undergo accreditation that included Member Connections or Care Management and Health Improvement will receive the icon. Plans that go through Quality Plus voluntarily, and fail, will not.

Q. How does a Quality Plus survey work?  

A. The current survey process for the voluntary Quality Plus content areas can be summarized in six steps: 

• The organization downloads the application and submits it to NCQA.    
• The organization schedules a survey date.  
• The organization receives, completes, and submits the Survey Tool on-line through NCQA’s Interactive Survey System.  
• Surveyors perform a review. Reviews for Member Connections and Physician and Hospital Quality are conducted off-site; there is an on-site file review for the Care Management and Health Improvement content area.  
• After the preliminary reviews are complete, the plan will be given the opportunity to provide comment. 
• NCQA’s Review Oversight Committee renders a decision. 

Q. Are HEDIS or CAHPS measures included in Quality Plus scoring?  

A.  Some CAHPS data is scored in Quality Plus content areas against benchmarks and thresholds. More detailed information is available in the Standards and Guidelines for each applicable content area.  

Q. Can Quality Plus surveys be performed at the corporate level?  

A.  NCQA can survey applicable functions at the corporate level and apply the results to all appropriate accreditation entities. Quality Plus decisions are only awarded at the accreditation entity level. 

Survey Decisions  

Q. Who makes the final decision on awarding Quality Plus distinction?  

A.  As with all NCQA Accreditation programs, final decisions regarding Quality Plus distinction are made by NCQA’s Review Oversight Committee.  

Q. How long is a Quality Plus decision valid?

A. For plans that do the Quality Plus areas voluntary, the following timeframes apply.
 
If a plan is accredited under the 2007 standards - which include some QP standards, then status duration is determined by the Accreditation status (e.g. just like any other standard such as CR, RR, QI, etc) 

For Member Connections, an Organization maintains a status of Distinction until the earlier of:

• the effective date of Organization’s accreditation decision for the first NCQA Accreditation survey, for the products in its commercial product line, that Organization undergoes after July 1, 2007; or
• the expiration, lapse, revocation, or other loss of Organization’s current MCO or PPO Accreditation status for the products in its commercial product line.

For Care Management and Health Improvement, an Organization maintains a status of Distinction until the earlier of: 

• three (3) years; or
• the expiration, lapse, revocation, or other loss of Organization’s current MCO Accreditation status for the products in its commercial product line.

For Physician and Hospital Quality, an Organization maintains a status of Distinction until the earlier of:

• three (3) years; or
• the expiration, lapse, revocation, or other loss of Organization’s current MCO Accreditation status for the products in its commercial product line.