June 14, 2006

Proposed NCQA Measures Hold Promise for Bringing Health Care Quality, Satisfaction Data to as Many as 130 Million

Draft specifications enable PPOs to report HEDIS® quality data for first time; public invited to comment through July 14

WASHINGTON—The National Committee for Quality Assurance (NCQA) today released for public comment a set of proposed modifications to its Health Plan Employer and Data Set (HEDIS®) specifications that will enable preferred provider organizations (PPOs) to collect and report clinical quality data across key dimensions of health care. HEDIS is the nationally recognized set of performance measures that health plans use to measure, report and improve their performance.

Six of every 10 commercially insured Americans are enrolled in PPOs; however, no standardized data exist to inform purchasers and consumers about the quality of care and service delivered by PPO plans. Increasingly, purchasers and regulators are calling for HEDIS performance information to help them make comparisons and purchasing decisions across the HMO and PPO products available. The Centers for Medicare & Medicaid Services (CMS) and the Federal Employees Health Benefit Program – have mandated that PPOs serving Medicare beneficiaries and federal workers report clinical quality and customer satisfaction data beginning next year.

“We’ve reached a point where it’s feasible for most PPO plans to collect and report quality data, as HMOs have been doing for years,” said NCQA President Margaret E. O’Kane. “These new specifications provide a roadmap for PPOs to provide their customers with detailed information on clinical quality. Plans that measure and report their quality don’t just say they add value, they demonstrate how they do it.”

While HMOs and point-of-service plans have collected and reported HEDIS data for over a decade, PPOs have only started to do so in the past few years. But recent changes to the health insurance market have further blurred the distinctions between PPOs, point-of-service plans and HMOs, leading to increased demand from purchasers and regulators for more specific, actionable data on quality and cost. Some PPOs have responded by implementing systems to support quality reporting: nearly 80 PPOs have collected and reported at least some clinical quality or customer satisfaction data to NCQA over the past two years.

CIGNA committed to reporting HEDIS PPO data to NCQA on a trial basis two years ago. “Consumers and employers want information about health care quality so that they can make more informed choices," states Jeff Kang, M.D., chief medical officer for CIGNA HealthCare. "Providing NCQA with data for benchmarking PPO plans helps give consumers and employers added information, and also provides us with data to continually assess quality and further strengthen the health advocacy programs we provide to our customers and members. We are pleased to participate in this initiative.”

Employers expressed support for expanded PPO performance data. “Without data on quality, outcomes and efficiency, you really can’t get a good handle on the value of your health care investment,” said Lawrence Becker, Director, Benefits, Xerox Corporation. “PPO reporting of HEDIS data will help us make more useful comparisons between plans, regardless of the types of plan we contract with, and we’ll know that our employees will be better served. These efforts on quality are a major step forward.”

Detailed HEDIS PPO draft specifications can be downloaded from NCQA’s Web site at www.ncqa.org. Those who wish to comment on the new measures may do so through July 14 by sending an e-mail to PPOhediscomments@ncqa.org. Final measure specifications will be released in October.

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.

HEDIS® is a registered trademark of the National Committee for Quality Assurance.
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