August 15, 2006

NCQA Seeks Public Input to Align HMO and PPO Accreditation Standards

Common standards will allow consumers, purchasers,
and regulators to directly compare health plan quality

WASHINGTON— The National Committee for Quality Assurance (NCQA) is working to help Americans better compare their health plan choices by developing a common set of quality standards to measure all health plans. The organization is reaching out to the health care industry, employers, consumers, public purchasers and others to gain input on how best to align accreditation standards for several types of health plan and drive greater improvement in the performance of the U.S. health care system.

Currently, 64.5 million Americans are enrolled in health plans that report performance data, providing consumers, employers and others with information to help them understand how well these plans deliver care that meets evidence-based guidelines. But more than 130 million people are in plans that do not report such data.

“The changing landscape of the American health care system has placed more responsibility for health care decision making on consumers,” said NCQA President Margaret E. O’Kane. “This can be a very positive change if we also provide the kind of ‘apples to apples’ comparative information that people need to make these decisions.”

Current NCQA MCO Accreditation standards evaluate performance for care management and health improvement and results based on the Health Plan Employer Data and Information Set (HEDIS®), the industry standard for measuring clinical performance. Current PPO Accreditation standards do not include such requirements. By measuring and reporting HEDIS results, NCQA has helped drive significant improvement in the quality of care. “Expansion of HEDIS reporting to PPOs can extend those benefits to millions of Americans,” said Phyllis Torda, NCQA Vice President for Product Development.

PPOs can be organized differently than HMOs. PPO customers are more likely to be national employers and to be self-insured. These structural differences raise some key questions to be considered as NCQA moves toward a single set of standards for different health plan types. NCQA is talking with consumers, employers, health plans and other stakeholders to understand how best to proceed on such key questions as:

• What is the appropriate unit for accreditation? Should national PPOs be accredited at that level or at a state level?
• What are the appropriate levels of HEDIS and CAHPS reporting (e.g., national, regional or state)?
• How should differences in benefits be addressed?
• How can NCQA best differentiate plan performance in its public reports?       

NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations, recognizes physicians and physician groups in key clinical areas and manages the evolution of HEDIS, the tool the nation’s health plans use to measure and report on their performance. 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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