ACCREDITATION: NCQA Puts Greater Emphasis On Results
Beginning next year, the National Committee for Quality Assurance will "incorporate measurements of quality when it decides which HMOs to accredit," the AP/Akron Beacon Journal reports (Meckler, 3/31). According to the group, the standards include selected performance measures from NCQA's Health Plan Employer Data and Information Set (HEDIS), making Accreditation '99 the nation's first true performance-based accreditation program. NCQA President Margaret O'Kane said, "Accreditation '99 uses three approaches to evaluating health plan quality -- rigorous standards, objective measures and customer satisfaction." HEDIS results will initially account for 25% of a plan's accreditation score, and the remaining 75% will be based on the plan's degree of compliance with NCQA standards. In the future, NCQA said it anticipates increasing the proportion of the accreditation score based on a health plan's performance. Consumer Coalition for Quality Health Care Senior Associate Andrew Webber said, "Accreditation should provide easy-to-understand information about a plan's strengths and weaknesses; it should speak to the consumer and help make the decision about what plan to choose easier." Webber added that Accreditation '99 "represents a big step forward in the national effort to promote quality in managed care" (NCQA release, 3/31).
The AP/Beacon Journal notes that the NCQA "has been collecting information for several years about how health plans stack up against one another." But the group "has never used [HEDIS] data to determine whether a plan will get its seal of approval" (3/31). Accreditation '99 reporting categories will include access and service, qualified providers, staying healthy, getting better, and living with illness. New standards that the NCQA believes will help to protect consumers include "prohibiting health plans from using financial incentives to encourage case managers to limit or deny care, requiring health plans to have a process for approving exceptions to restricted drug formularies, evaluating whether health plans unduly limit access to emergency room care, and requiring health plans to coordinate medical and behavioral health care." NCQA is also creating new information system standards requiring plans to ensure the security and confidentiality of members' data and information.
Rolling With The Plan
NCQA mailed the standards to nearly 2,500 business coalitions, employers, health plans, medical groups, associations, regulatory bodies, and other groups to encourage broad comment. The full text of standards is available for download from NCQA's Web site, located at www.ncqa.org/99draft.htm (3/31). NCQA noted that it worked with the Foundation for Accountability (FACCT) and others to develop and test the new categories in Accreditation '99.