September 13, 2007

14 PPOs PUBLICLY COMMIT TO NEW ACCREDITATION STANDARDS
More Than 10 Million Americans Stand to Benefit from Improved Care

WASHINGTON—Fourteen of the nation’s leading preferred provider organizations (PPOs) covering 10.2 million Americans are among the first to come forward for evaluation under NCQA’s new Health Plan Accreditation standards [see attached list]. The program evaluates PPO and managed care plans under a common set of standards, allowing consumers, employers and other purchasers of health care to make understandable, reliable comparisons among different types of health plans to better inform their health care choices.

While PPOs cover more than 6 in 10 Americans, they have not historically engaged in systematic clinical quality reporting efforts. “The millions of Americans enrolled in PPO plans deserve information about how well their plans help protect and promote their health," said NCQA President Margaret E. O’Kane. “That information hasn’t traditionally been available, but these PPOs are at the vanguard of change. I look forward to other plans following their lead.”

Beginning July 1, 2008, PPOs seeking NCQA Accreditation will be required to report clinical quality results through NCQA’s Health Effectiveness Data and Information Set (HEDIS®), the nation’s most widely used set of clinical quality measures. The results of those measures will account for nearly 40 percent of the plan’s accreditation score. PPOs will also be reviewed on a set of standards common to managed care organizations including an assessment of their complex case management and disease management programs as well as how well they ensure continuity and coordination of patients’ care.

The plans adopting the new Accreditation standards join 22 other PPOs covering 30 million Americans that have earned or are currently seeking NCQA Accreditation.

Additionally, 83 PPO plans—covering about 20 million Americans—voluntarily reported HEDIS data to NCQA in 2007. Many of these plans have agreed to come forward over the next three years under the new standards in conjunction with an HMO product offered by the same insurer.

Health plan leaders see HEDIS reporting as an opportunity to demonstrate value. “Publicly reporting our HEDIS results allows us to demonstrate to our members the high level of care and service we provide,” said Norman Lindenmuth, M.D., vice president and chief medical officer for quality, Excellus BlueCross BlueShield. “As employers and consumers become more sophisticated in their health care purchasing decisions, providing quality data helps us distinguish ourselves in the marketplace.”

The demand for greater quality reporting among PPOs has also come from purchasers and regulators in the public and private sectors. Employers and consumers are interested in using quality data to inform health plan contracting; 48 major employers and consumer advocates have endorsed the new NCQA Health Plan Accreditation Standards [see attached list]. Medicare and the Federal Employees Health Benefits Program now require PPOs to report HEDIS data and U.S. Health and Human Services Secretary Michael Leavitt has called for a value-based purchasing agenda that includes quality reporting and transparency.

States also are looking for ways to expand PPO quality reporting. California Insurance Commissioner Stephen L. Poizner has announced plans to produce a statewide PPO report card for consumers based on HEDIS data in 2009. “The quality of health care should not be a mystery,” said Commissioner Poizner. “Evaluating PPOs on the same standards as managed care plans makes sense for consumers and their families. Consumers should know what they’re getting when they pay their health care premiums.”

For more than a decade, NCQA has collected and publicly reported on the quality of care delivered by HMOs through HEDIS. Health plans that publicly report their quality data have consistently outperformed those that do not, saving lives and reducing costs. For instance, improvements among accountable plans over the past seven years in controlling high blood pressure have saved as many as 83,000 lives.

For more information about NCQA’s new Health Plan Accreditation Standards, visit http://www.ncqa.org/. PPOs interested in seeking accreditation under the new standards should contact Jeannie Simpson, NCQA 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.

PPOs SEEKING ACCREDITATION UNDER NEW HEALTH PLAN STANDARDS

• Anthem Health Plans of Virginia, Inc. d/b/a Anthem Blue Cross Blue Shield
• Blue Cross and Blue Shield of New Mexico
• Blue Cross and Blue Shield of Vermont
• Blue Cross of California
• Excellus BlueCross BlueShield, Rochester Region (N.Y.)
• Excellus Health Plan, Inc. d/b/a Upstate (N.Y.)
• Geisinger Health Plan (Pa.)
• Harvard Pilgrim Health Care, Inc. (Mass.)
• Health Partners, Inc. (Minn.)
• HIP Health Plan of New York
• Medical Mutual of Ohio
• QCC Insurance Company (a subsidiary of Independence Blue Cross) (Pa.)
• Tufts Health Plan (Mass.)
• UnitedHealthcare Insurance Company (Calif.)

ORGANIZATIONS ENDORSING NCQA’s HEALTH PLAN ACCREDITATION STANDARDS

• 3M
• AARP
• AFL-CIO
• American Hospice Foundation
• Bridges to Excellence
• Business Health Care Action Group
• CBS Corporation
• Center for Medical Consumers
• Chevron
• 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
• Johnson & Johnson
• Kennametal Inc.
• Kellogg Company
• The Leapfrog Group
• Marriott International
• Maureen Cotter & Associates
• McKesson Corp.
• Memphis Business Group on Health
• MidAtlantic Business Group on Health
• Midwest 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
• Provisional Benefits Group, Inc. 
• SEIU
• St. Louis Area Business Health Coalition
• UPS
• Watson Wyatt Worldwide
• Xerox

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