April 19, 2004

NCQA CONVENES EXPERT PANEL TO DISCUSS CONSUMER AND PURCHASER NEEDS IN AN EVOLVING HEALTH CARE MARKET

Public-private group to consider implications of changes in health care system; accreditation, information requirements expected to evolve

WASHINGTON—The National Committee for Quality Assurance (NCQA) has convened a new Strategic Work Group to consider how changes to the U.S. health care system are prompting demands for new and different types of information about health plan and provider performance and value.  The group will also comment on how to adapt NCQA’s programs to better address these new information needs and help purchasers and consumers distinguish among health plans and providers in the market.  The group’s input will help shape NCQA’s plans to evolve many of its key accreditation programs, making them more broadly applicable to today’s array of health plan options, more useful for consumers and employers, and more focused on identifying value and efficiency.

“Technology, economics, the types of plans being offered, even the role of the patient – these have all changed.  We expect different things from health plans and providers today than we did five years ago,” said NCQA President Margaret E. O’Kane. “The work group will provide expert perspective on how to align our efforts with the current system so we can better inform purchaser and consumer choice.”

The Strategic Work Group will bring together notable industry leaders representing a broad base of health care stakeholders including employers, physician and consumer advocates, health plan representatives and policy leaders (see list below).  The group includes some of the most distinguished voices of the medical, academic and business communities, including key decision-makers at influential non-governmental organizations and top policymakers at the federal and state level.

In addition to conducting a meeting of the Strategic Work Group, NCQA expects to conduct focus group research and convene additional expert panels to look into technical issues around information and reporting in specific areas.

The Work Group will consider the implications of key trends and changes such as the improvement in available information technology and the development of new types of health plans on the tools consumers and purchasers need to make good choices.  Changes in these and other areas have altered the way care is selected, delivered and coordinated and the types of questions asked by purchasers and consumers when choosing among provider and health plan options.  For example, more and more consumers are today considering consumer-directed health plans; these organizations did not exist when current accreditation and measurement models were created. 

“Employers’ expectations of health plans have changed. They are looking for ways to choose plans that engage consumers in their care and get employees to the best, most efficient providers,” said Peter Lee, J.D., President and CEO, Pacific Business Group on Health. “By building these expectations into NCQA’s programs, employers will have a tool that allows them to consider more than this year’s premium and make purchasing decisions based on value as much as price.”

The group will also consider how transparency and better information can lead to faster adoption of activities that improve value, such as using incentives to improve performance and ensuring good coordination and communication across different organizations and between patients and doctors.  Leading health plans have adopted these and other strategies successfully in recent years.  Today, more than 40 health plans (as well as Medicare) participate in some sort of pay-for-quality program to reward and encourage physicians who embrace new practice patterns, outreach activities or technologies that improve care.

“If accreditation doesn’t recognize and reward health plans for being smart about the way they coordinate care and providers for how they deliver care, there is a real risk these things won’t happen,” said Robert Berenson, M.D., Senior Fellow at The Urban Institute. “But they are both highly effective ways to improve clinical care.  We want to encourage all plans to do the same.”

The work group will also consider the right role for health plans in informing consumers’ choice among physicians and hospitals.  Many plans are now providing physician- and hospital-level quality data and recognizing top performers in network directories.

“Five years ago, the technology necessary to do this didn’t exist,” said Jay Gellert, President and CEO of HealthNet and Chair of the Strategic Work Group. “Today it’s doable, we know that consumers want it and we know that it promotes excellence. The logical next step is to increase the availability of comparable and actionable information and report on which plans and providers are doing it well.”

NCQA expects that its next generation assessment programs will be flexible enough to apply to a variety of different types of organizations such as managed care organizations, preferred provider organizations, disease management vendors and consumer-directed health plans.

The meeting of the group is scheduled for May 6-7.  NCQA may launch its first new programs based on the group’s input by late 2004.

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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NCQA’s Strategic Work Group

• Charles D. Baker, President and CEO, Harvard Pilgrim Health Care
• Robert A. Berenson, M.D., Senior Fellow, The Urban Institute
• Bruce Bradley, Director, Health Plan Strategy and Public Policy, General Motors
• Jay Crosson, M.D., Executive Director, The Permanente Foundation
• Helen Darling, President, National Business Group on Health
• F. Daniel Duffy, M.D., Executive Vice President, American Board of Internal Medicine
• Elliot Fisher, M.D., M.P.H., Professor of Medicine and of Community and Family Medicine, Dartmouth College
• Jay M. Gellert, Chair; President and CEO, HealthNet
• Karen Ignagni, President and CEO, AHIP
• Peter V. Lee, J.D., President and CEO, Pacific Business Group on Health
• Jack Lord, M.D., Chief Innovation Officer, Humana
• Debra L. Ness, Executive Vice President, National Partnership for Women & Families
• Len M. Nichols, Vice President, Center for Studying Health System Change
• Sandy Praeger, Commissioner, Kansas Department of Insurance
• Michael Rothman, Senior Program Officer, Robert Wood Johnson Foundation
• Reed V. Tuckson, M.D., Senior Vice President, Consumer Health & Medical Care Advancement, UnitedHealth Group
• Sean Tunis, M.D., M. Sc., Director, Office of Clinical Standards and Quality, CMS
• I. Steven Udvarhelyi, M.D., Chief Medical Officer, Independence Blue Cross