Employers, Unions, Consumer Advocates Endorse New NCQA Health Plan Accreditation Standards

New Standards Expand Reporting Requirements for Clinical Quality, Service to All Plans Seeking Accreditation

WASHINGTON—Preferred provider organizations (PPOs), which cover nearly two-thirds of all privately insured Americans, will be required to report on the quality of care and service their members receive under standards released today by the National Committee for Quality Assurance (NCQA). All health plans – including HMOs and PPOs – will be evaluated under the same set of standards. A broad cross-section of 41 employers, labor unions, policymakers and consumer advocates endorsed the new standards [see attached list].

Americans spend almost twice as much per capita on health care as other industrialized nations, but often receiver lower quality care. For more than a decade, NCQA has measured and publicly reported the quality of care delivered by HMOs through its Healthcare Effectiveness Data and Information Set (HEDIS®), the most widely used measure of quality in the nation. Plans that measure and publicly report their quality data routinely outperform those that do not, saving lives and reducing costs.

Under the new Health Plan Accreditation standards released today, PPOs seeking NCQA Accreditation will be required to report clinical quality results through HEDIS. While nearly 150 million Americans are enrolled in a PPO, most such plans do not collect and report quality data. In 2006, 80 PPOs submitted HEDIS data to NCQA; a similar number are expected to do so this year.

Evaluating health plans on a common set of standards will allow consumers, employers and other purchasers of health care to easily compare the performance of all plans and make the choices that best fit their needs. “PPOs cover 150 million Americans, yet we know disturbingly little about the quality of care they deliver," said NCQA President Margaret E. O’Kane. “In order for employers and families to make good comparisons and informed choices, it only makes sense to build upon the success we’ve had in measuring the quality of managed care organizations by asking PPOs to do what HMOs have done for years.”

Major U.S. employers welcomed the new standards and promised to ask their plans to become NCQA Accredited. "At 3M, we think of what we spend on health care benefits as an investment in health rather than an investment in health care," said Jack Arland, North America Benefits Manager, 3M. "We need to know which plans are best at protecting and improving our employees' health, and HEDIS results are a good indicator. That's why we strongly support the new standards, and we plan to ask all the PPOs we do business with to pursue NCQA Accreditation."

Benefit consultants also lauded the new standards. "Employers know that a healthy, productive workforce is a tremendously valuable asset," said Ted Nussbaum, director of group and health care consulting in North America, for Watson Wyatt Worldwide, one of the world's leading consultants on people and financial issues, including employee benefit programs. "Now that PPO plans have shown that it's possible to report HEDIS data, employers can begin to ask plans that don't currently do so to start - it's a very direct way of demonstrating a plan's added value and showing how well a plan helps protect employee health."

Health policymakers in Washington and around the country have recognized the need for more widespread quality reporting by PPOs. The Medicare program and the Federal Employees Health Benefits Program now require PPOs to report HEDIS data. In August 2006, President Bush issued an Executive Order directing U.S. agencies to advance an agenda of quality and price transparency in health care and U.S. Health and Human Services Secretary Michael Leavitt has been working with communities around the country to advance a value-based purchasing agenda that includes quality reporting and transparency.

For more information about NCQA’s new Health Plan Accreditation Standards, visit www.ncqa.org. PPO plans interested in becoming Early Adopters of the new standards are encouraged to contact Jeannie Simpson, Director of Customer Outreach, at (202) 955-5137.

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 recognizes physicians in key clinical areas. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS) is the most widely used performance measurement tool in health care.  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.

ORGANIZATIONS ENDORSING 2008 ACCREDITATION STANDARDS

• 3M
• AFL-CIO
• American Hospice Foundation
• Bridges to Excellence
• Business Health Care Action Group
• CBS Corporation
• Center for Medical Consumers
• Childbirth Connection
• Chrysler Corporation
• Citizen Advocacy Center
• Colorado Business Group on Health
• Consumers Advancing Patient Safety
• Consumers' CHECKBOOK/Center for the Study of Services
• Consumers Union
• Eastman Chemical Company
• Families USA
• Ford Motor Company
• General Electric Company
• General Motors
• Health Care For All
• Independence Blue Cross
• Kennametal Inc.
• Marriott International
• Maureen Cotter & Associates
• MidAtlantic Business Group on Health
• National Business Coalition on Health
• National Business Group on Health
• National Coalition for Cancer Survivorship
• National Consumers League
• National Partnership For Women and Families
• New York Business Group on Health
• Pacific Business Group on Health
• Pfizer, Inc.
• Pitney Bowes
• SEIU
• St. Louis Area Business Health Coalition
• The Leapfrog Group
• UPS
• Watson Wyatt Worldwide
• Xerox

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