July 31, 2006
New NCQA Accreditation Stadards for Managed Care Plans Highlight Member Engagement, Wellness, Care Management
Select Quality Plus content areas added to Accreditation for 2007
Health plans seeking accreditation from the National Committee for Quality Assurance (NCQA) will be required to demonstrate that they provide their members with information to help them navigate the care system, and have programs in place to promote wellness and manage complex conditions. The new standards, previously part of NCQA’s voluntary Quality Plus program, reflect an increased desire among consumers, employers and plans to involve patients more directly in their care.
Since NCQA first launched these standards in 2005 as part of a voluntary program, NCQA has conducted or scheduled 130 health plan surveys for these standards. Member Connections and Care Management and Health Improvement, two content areas are being integrated into NCQA’s Accreditation beginning next year.
“Activating health care consumers and providing them with customized care management are critical to the future of affordable, quality health care,” said Peggy O’Kane, President of NCQA. “Plans demonstrated their strong commitment to providing these services through their adoption of these programs when they were voluntary.”
Other changes for 2007 include the addition of a new Physician and Hospital Directories standard that assesses what information health plans provide members through Web-based directories, what features the directories offer for searching, how the information is explained to members, whether the health plan tests the usability and provides access to the information using a means other than the Web.
Beta Blockers: Building on Success
NCQA also announced that due to a sustained period of high performance among plans it will no longer score the “Beta Blocker Treatment after a Heart Attack” HEDIS measure for Accreditation. Use of beta-blockers following a heart attack reduces the possibility of a second – and often fatal – heart attack. The dramatic rise in beta-blocker treatment rates demonstrates that sustained attention and effective initiatives can save lives and improve quality of life. In 1996 the average score for Accredited health plans was 62.6 percent. By 2005 it had risen to 96.7 percent, with minimal variation among plans.
The beta-blocker measure will be replaced by the “Persistence of Beta-Blocker Treatment After a Heart Attack” HEDIS measure for commercial and Medicare plans in order to track whether patients continue to receive treatment at least six months after a heart attack. Additionally, the Glaucoma Screening in Older Adults measure has been added to Accreditation scoring for Medicare plans beginning in 2007.
Visit NCQA’s Web site at www.ncqa.org to learn more and to order a copy of the 2007 Accreditation standards. NCQA will host educational seminars in the fall on the new standards.
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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