Once Again, Our Program Is the Model for Quality

August 26, 2016 · NCQA Communications

In 1990, Peggy O’Kane founded the National Committee for Quality Assurance (NCQA) on the belief that patients deserve safe, high-quality health care. Peggy also believed that doctors should not be paid simply for the number of services they deliver, but for the value of those services.

In 1990, not many agreed with her. Today, that idea is at the forefront of national health care reform.

Peggy and NCQA pioneered much of the work defining and measuring quality, with the goal of transforming our health care system from paying for volume to paying for value. Paying for value can greatly improve the quality, cost and beneficiary experience of care by rewarding clinicians for high-quality, efficient care. This fundamental concept was passed into law by Congress as the Medicare Access & CHIP Reauthorization Act (MACRA).

One way MACRA will help reach the goal of value-based care is by promoting Patient-Centered Medical Homes (PCMH) and Patient-Centered Specialty Practices (PCSP), which are designed to transform the delivery of care into what patients want it to be. NCQA has the nation’s largest PCMH program, with more than 56,000 recognized clinicians. That includes over 17 percent of all primary care physicians in the U.S. NCQA also has the nation’s only PCSP program.

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In 2005, with the idea that generating competition can generate improvement, NCQA started rating and comparing accredited health plans based on the quality of care they provide to members. Recognizing the power of this model to improve cost, quality and patient experience, in 2010 the federal government created a similar rating system for Medicare Advantage plans, through the Affordable Care Act. Payments were tied to plans’ Star Ratings.

In the last six years, average Star ratings have improved consistently. In the first year of the program, 14% of MA plans earned at least 4 stars. Today, 49% do. And consumers have responded. Over 70% of MA enrollees are now in plans with 4 stars or more, compared with 31% in 2012.

In 1990, Peggy and NCQA were considered radical for driving the “value agenda”; today, it’s the national agenda. Now is the time to work together to support our health care providers—especially those in small and rural practices—and to ensure that value-based health care is available to all Americans.


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