What We Do
Our work at the federal level focuses on what we care about most: patients.
NCQA works with federal lawmakers and regulators in a number of important areas including quality improvement, quality measure development, patient-centered care, health plan accreditation, long-term services and supports (LTSS), behavioral health integration and more.
NCQA’s Federal Affairs team meets regularly with Members of Congress and their staffs to share data related to health care quality and educate them on the benefits of patient-centered, high-quality health care. Additionally, the team files comment letters on various federal policies.
We also work with the US Department of Health and Human Services (HHS) and other agencies to find ways to improve the care provided through the federal government.
Accelerating Improvement, Reducing Burden and Achieving Greater Value in Health Care
For more than 30 years, quality measurement has driven remarkable improvements in health care—but the current quality measurement system, which collects data manually, is fragmented, labor-intensive, inconsistent and retrospective. Digital quality measures (dQM) that use interoperability standards offer a unique opportunity to expand the use of high-quality, standardized information from across the clinical and public health data spectrums. These measures are a critical component of a fully interoperable learning heath system that generates accurate and reliable knowledge at a time when it is most valuable.
Implementing technologies that move away from paper-based reporting can be resource intensive and time consuming. CMS has released a strategic roadmap calling for all-digital reporting in the next decade. NCQA supports the move to a fully digital public health reporting ecosystem, with dQMs as a core component.
The Medicare Access and CHIP Reauthorization Act (MACRA) changes the way Medicare pays doctors. It moves the payment system closer to paying for value, rather than volume. Read our comment letters and find out more on NCQA’s work on MACRA here.
Medicare Advantage Quality Measurement
Medicare Advantage (MA) health plans are offered by private companies that contract with Medicare. More than 11 million Americans are members of Medicare Advantage plans that have earned NCQA Health Plan Accreditation.
All MA plans report their performance on the Healthcare Effectiveness Data Information Set (HEDIS®). Results are included in Star Ratings on the quality of each plan. The Star Ratings helps people make apples-to-apples comparisons between their options, and Medicare also uses them to adjust payment to reward plans for quality.
Results show that NCQA-Accredited plans perform better. Our plans deliver better care at a statistically significant level on several critical measures, including access to care, diabetic blood sugar control, cholesterol and blood pressure control, breast and colorectal cancer screening and counseling enrollees on nutrition and physical activity.
Medicare Advantage “Deeming”
Medicare also has authority to use a plan’s NCQA accreditation status as proof that a plan has met program requirements in areas like quality improvement, access to care and privacy. This process, known as “deeming” or “non-duplication”, allows plans and the federal government to avoid duplicative reviews and focus on other enforcement priorities.
We are now working to apply this authority to Medicare Advantage Special Needs plans (SNPs) through a program in which NCQA could verify for Medicare that the plans are implementing the models of care their enrollees need.
HEDIS® Quality Measurement
Medicare and other federal programs, along with states and most commercial insurers, use quality measurement to track performance and put in place value-based payment models throughout the health care delivery system.
HEDIS® measures cover different domains of care that include effectiveness and access to care. NCQA is responsible for maintaining and evolving HEDIS measures for patients in Medicare, Medicaid and CHIP, ACA, Exchange and employer plans.
Federal Employees Health Benefit Program (FEHB)
The Federal Employees Health Benefit Program also recognizes NCQA Accreditation. In doing so, it notes that NCQA provides “an impartial opinion about” plan quality, and our accreditation levels “help consumers make more informed health care decisions.” A majority of the FEHBP enrollees are in NCQA accredited plans.
NCQA and State Exchanges
Under the Affordable Care Act, each state has a “exchange” where individuals can shop for health insurance and see if they qualify for subsidies to help pay for it. All Exchange plans must meet specific quality requirements and must be accredited based on their actual performance.
NCQA accredits about 85% of all Exchange plans.
NCQA regularly responds to Requests for Information and other public comment solicitations put out by federal agencies. We also periodically weigh in on pending legislation. Read all our comment letters here.