August 2, 2004

NCQA’s NEW “QUALITY PLUS” PROGRAM TO HIGHLIGHT INNOVATIVE, WEB-ENABLED HEALTH PLANS; PROGRAM TO ALLOW LEADERS TO MEET TOUGH NEW STANDARDS EARLY 

Initial draft standards focus on “connections” with members, claims; participants to receive special distinction on report cards, preview of future requirements

WASHINGTON—The National Committee for Quality Assurance (NCQA) today released for public comment draft standards for “Quality Plus,” a new supplemental accreditation program that in content and intent breaks new ground for NCQA.  The program is designed to highlight health plans whose innovative approaches to member communications, care management, physician compensation and other activities are models for the industry. The voluntary program also seeks to engage newer health plan types such as consumer-directed health plans that represent a growing sector of the health care.  The initial set of draft standards focus on how well a plan uses technology to provide members with interactive health tools and information about pharmacy benefits, claims and health improvement. 

“NCQA’s mission is to improve health care quality, and Quality Plus will allow us to better recognize leaders and innovators regardless of plan type,” said NCQA President Margaret E. O’Kane. “Recognizing these innovations will speed their adoption so that in the future we’ll all be able to do things like track claims on the Web, order prescription refills on-line and get answers to our questions 24 hours a day.”

Employers played a central role in the discussions that informed the development of Quality Plus and have been strong supporters of the effort.  “A lot of good health plans meet the standards of the day, but only a few set the standards of tomorrow,” said Peter Lee, J.D., President and CEO, Pacific Business Group on Health. “Those that do deserve credit and that’s what Quality Plus is all about.  With Quality Plus, employers and consumers can make sure plans keep pushing the quality envelope; it’s the market saying, ‘We’re watching and we appreciate what you’re doing.’”

Because the Quality Plus program is voluntary, it will allow NCQA to introduce standards related to activities and strategies that are still rare in the industry much earlier than would otherwise be practical.  Quality Plus standards will focus on cutting edge practices in areas such as information technology, chronic care management and physician and hospital assessment.  Many of these new standards will become part of a new generation of accreditation programs slated for release in 2007.

Health plan reaction to Quality Plus has been positive. “The Quality Plus standards focus on the issues that matter to consumers,” said Gifford Boyce-Smith, M. D., Senior Medical Director, Quality Management, Blue Shield of California. “Can I count on getting the screenings, care and support I need? Does my doctor measure up? And if I have a question, how quickly can I get an answer?  We’re looking forward to being reviewed against these standards and showing our members that they’re in good hands.”

The Quality Plus program is part of NCQA’s multi-year effort to transition to a more flexible generation of measurement and accreditation programs aimed at a wider range of organizations.  Through Quality Plus, NCQA will introduce new standards that will give employers insight into whether or not a plan represents a good value, as well as standards designed to encourage more focused care management.  Quality Plus standards fall broadly into three areas.  They are: 

• Member Connections: Do members have access to interactive information?  Can they track claims?  How functional is the plan’s Web site? Do they take advantage of available technology to provide good service? Can they engage in a health risk appraisal? (released today for public comment)
• Physician & Hospital Quality: Does the plan regularly measure and report on the performance of network doctors and hospitals?  Are physicians given any incentives for delivering high quality care?  Do members have incentives for selecting a high quality physician? (To be released 3/05)
• Health Improvement: Does a plan offer its members specific services based on their own unique health status?  How effectively does the plan manage chronic conditions? Does the plan work to make all its members healthier?  (To be released 3/05) 

Information from the three additional categories of standards will be added to NCQA’s Health Plan Report Card, available at www.healthchoices.org., to help consumers and employers make more informed choices about their health care coverage.

“Quality Plus will bring health plan innovators more recognition and that will motivate the rest of the industry to embrace change,” said Richard Snyder, M.D., Vice President, Quality Management, Independence Blue Cross. “It will definitely accelerate the pace at which effective new technologies, payment strategies and approaches to member service are adopted by the industry – no health plan wants to be without a seal of approval that its competitor has.”   

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.

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