March 6, 2006

NCQA to Add “Quality Plus” Content Areas to 2007 Accreditation Requirements

New standards respond to employer and consumer interest in health plan prevention, disease management, communication; public comment through April 7

WASHINGTON— The National Committee for Quality Assurance (NCQA) today released for public comment draft standards for its 2007 Accreditation and Certification programs, notable among them programs for managed care organizations (MCO) and  preferred provider organizations (PPO). Interested parties are encouraged to comment on the draft through April 7.

Among the most significant changes to the standards are the inclusion of two new content areas for MCOs and PPOs seeking Accreditation and the inclusion of four new HEDIS® measures in Accreditation scoring for MCOs.

Previously a voluntary supplement to Accreditation, the two Quality Plus content areas—Member Connections and Care Management and Health Improvement—have enjoyed significant support from employers and purchasers. Health plans have also been responsive to the program: to date, more than 130 surveys on the Quality Plus standards have been conducted or scheduled.

Three of the HEDIS measures proposed for Accreditation scoring assess important medical outcomes in areas of cardiac and diabetes care. The fourth measure assesses glaucoma screening among members of Medicare Advantage plans.

“Employers and consumers considered activities such as online claims tracking and enhanced communication with members about their health exceptional two or three years ago, but expect those things from their health plan today,” said NCQA President Margaret E. O’Kane. “The swift adoption of the Quality Plus standards by so many plans is a credit to their responsiveness, and a signal that we should expect all our Accredited plans to operate at such a high level.”

Two Quality Plus content areas are scheduled for inclusion in Accreditation requirements for MCOs and PPOs beginning in 2007:

• Member Connections standards assess how effectively MCOs and PPOs interact with their commercially insured members to make sure they understand their benefits, provide tools for wellness and self-management and allow for claims tracking.
• 
  Care Management and Health Improvement standards, building upon existing MCO disease management standards and HEDIS measures, assess MCOs’ wellness programs and management of chronic conditions and complex cases.

In addition, four HEDIS measures are proposed for inclusion in MCO Accreditation scoring for 2007:

• Persistence of Beta-Blocker Treatment After a Heart Attack
• Glaucoma Screening in Older Adults
• Comprehensive Diabetes Care—HbA1c Poorly Controlled (>9.0%)
• Cholesterol Management for Patients With Cardiovascular Conditions—LDL-C Controlled (<100 mg/dl) 

One HEDIS measure, Beta-Blocker Treatment after a Heart Attack, will be retired from Accreditation scoring owing to a sustained period of high performance by health plans on this measure. In 2005, the average score for Accredited health plans was 96.7 percent for the Beta-Blocker measure. 

Results of measures that address cardiac and diabetes care, as with all measures scored for Accreditation that address chronic care, will be included in the Living With Illness reports on NCQA’s Health Plan Report Card, available online at http://www.ncqa.org/.

The draft standards also propose the modification or elimination of several elements in order to streamline the requirements and make them consistent across all NCQA Accreditation or Certification programs. The public comment materials contain a complete listing of the elements slated for revision or retirement.

Public comment materials can be downloaded from NCQA’s Web site at http://www.ncqa.org/. Comments should be submitted to Accred2007@ncqa.org by 5:30 PM EST on April 7. The final MCO, PPO and MBHO Standards and Guidelines will be released in late July; Standards and Guidelines for all other programs will be released in early December. 

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 manages the evolution of HEDIS®, the performance measurement tool used by more than 90 percent of the nation’s health plans. NCQA is committed to providing health care quality information free of charge through the Web and the media to help consumers, employers and others make more informed health care choices.

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