Employer Toolkit

Employer Toolkit

Driving Health Plan Quality

A Call to Action for Employers

Driving Health Care Quality: A Call to Action

Since the 1990s, NCQA’s Health Plan Accreditation, HEDIS®1 (Healthcare Effectiveness Data and Information Set) and CAHPS®2 (Consumer Assessment of Healthcare Providers and Systems) have provided a way for employers to understand the quality of care offered by health plans. Combined, these three programs help employers understand a plan’s performance and its ability to positively affect employee health.

Employers have long struggled to keep up with the ever-increasing costs of providing health care to their employees, yet the underlying issue driving much of these costs, poor quality care, remains. In recent years, employers have implemented programs to improve health care quality by addressing gaps in care and directing employees to high-quality providers. These programs have undoubtedly improved care for employees. However, they may unintentionally disincentivize the health plan from improving their networks’ performance.

Learn more about how employers can assess, mandate and incentivize health plan quality.

Assessing Health Plan Quality

Leveraging NCQA Data to Choose a Quality Partner

The Accreditation process provides employers with data and information they can use to ensure that they select a health plan partner that emphasizes quality processes and outcomes. As employers begin the selection process, they should ask current and prospective plans specific questions.

Learn more about how you can leverage NCQA data to assess your health plan quality, and questions you should ask during the RFP process.

Mandating Health Plan Quality

Contract Language Demonstrating the Employer’s Expectations of Quality

Employers can take a more assertive approach to health care quality by requiring health plan partners to achieve minimum thresholds of acceptable performance.

Learn more about the contract language top employers are using to ensure plans are committed to quality

Incentivizing Quality Improvements

Using HEDIS to Align and Improve Health Care Quality

Even though data shows that health plan performance varies significantly, there is little incentive for plans to improve the care they offer. Employers—and self-insured employers, specifically—can change this paradigm by aligning incentives to health care quality. This sends the message that quality is important and holds plans accountable for their performance. It also drives year-over-year improvements in health care quality at the population level.

Learn more about using HEDIS to align and improve health care quality.

Learn More About The Programs

What’s in Health Plan Accreditation?

NCQA developed the Health Plan Accreditation (HPA) program to provide an independent and unbiased review of health plan performance. HPA ensures that plans have the processes, policies and procedures in place to deliver quality care, and it brings transparency to the outcomes they achieve across their network.

Learn More About HPA

Learn more about the standards plans must meet to become NCQA accredited and the data HPA provides employers to evaluate the performance of current and prospective health plans.

What is HEDIS?

HEDIS, the Healthcare Effectiveness Data and Information Set, is a standardized population health management tool that employers can use to understand the health of their employees and measure the quality of care their population receives.

Data collected from health plans, health care organizations and government agencies are used to determine the effectiveness of care provided to plan members.

Learn More About HEDIS

Learn more about what HEDIS tells employers and how employers can use HEDIS data.

What is CAHPS?

CAHPS—the Consumer Assessment of Healthcare Providers and Systems—was developed by the Agency for Healthcare Research and Quality (AHRQ) and is the national standard for measuring patients’ experience with health plans. CAHPS data helps plans identify their strengths and weaknesses and implement strategies to address needed improvements.

Learn More About CAHPS

Learn more about when CAHPS surveys are completed by health plans and when they are submitted to NCQA, in order to earn Accreditation.