For consumers and employers, health care quality is an issue that hits the bottom line. We know that when we are in good health, we are more productive – able to work, care for our families, learn and grow. Poor quality health diminishes the competitive edge of American businesses in the global marketplace. With increasing premiums, the question purchasers ask, “How much does this health plan cost?” has become “How much value does this health plan provide?”
Today, more than two thirds of Americans covered by private health insurance are enrolled in PPO plans, the fastest growing sector of the health care industry. Yet we currently know alarmingly little about the quality of care delivered by PPOs. While a growing number of PPOs voluntarily collect and report data on care quality, most do not.
In August 2007, NCQA announced new Health Plan Accreditation Standards for 2008, which is designed to distinguish plans that demonstrate a commitment to measurement, transparency and improvement across all product lines by expanding HEDIS requirements for clinical quality and service to all types of health plans.
Due in large part to employer support, 14 PPOs, listed below, covering a combined 10 million Americans, have committed to come forward for NCQA's new Health Plan Accreditation in 2008. Unfortunately, that leaves more than 100 million Americans in PPOs that have not yet made that commitment.
We need your support by letting the plan with which you do business know you support NCQA Health Plan Accreditation for PPOs. Please let your plans know that you want them to participate by sending an email or letter. We have provided some sample language here.
Significant changes to Health Plan Accreditation for 2008
NCQA´s new Accreditation standards:
- Require all plans—including, for the first time, PPOs—to report on the quality of care through HEDIS® and CAHPS®.
- Require PPO plans to evaluate their disease management, wellness and complex case management programs.
- Establish common requirements for all plans, allowing consumers, employers and purchasers to compare performance across all plan types.
- Allow PPOs to achieve an “Excellent” Accreditation outcome for the first time.
Why NCQA Made The Changes
- The quality of health care in the U.S. remains highly variable. Respected studies find that, on average, Americans receive the right care only slightly more than half of the time.
- Consumers, employers and other purchasers of health care services are demanding greater value for their significant investment in health care coverage.
- Quality measurement and reporting drives improvement. Today, children in health plans that measure and report on quality are three times as likely to have had all recommended immunizations as they were 10 years ago; diabetics in these plans are twice as likely to have their cholesterol controlled to recommended levels as they were in 1998.
How Can You Help?
The support of consumers, employers, unions and other purchasing leaders will be crucial to driving adoption of these standards across plan types. We ask you to consider taking these four actions:
- Talk with your health plans. Let your health plans know you endorse NCQA’s drive to include PPO plans in reporting important quality data. Urge them to bring their PPO plans forward for NCQA Accreditation.
- Add language to your contracts with plans. By adding language to your next Request for Proposals, you send a powerful signal to interested health plans that they must prove the value of their services by passing the most rigorous test in the nation.
- Talk with your colleagues. Pass this information along to your colleagues. Encourage them to join you in publicly endorsing this important initiative.
- Publicly endorse the new Accreditation standards. Allow the name of your company or organization to be listed as supporting these new standards.