NCQA: Awards ‘Excellent’ Ratings to 40 National HMOs
The National Committee for Quality Assurance has awarded 40 health plans across the nation "Excellent" status by virtue of their commitment to clinical excellence, customer service and continuous improvement. The "Excellent" rating is the NCQA's new high honor. The top plans, while also scoring high marks for demonstrating "superior clinical and administrative processes" also earned high grades in performance measures including mammography and immunization rates, beta blocker treatment after a heart attack, prenatal care, eye exams for diabetics, advising smokers to quit and overall patient satisfaction. Prior to receiving the "Excellent" rating, the plans had to earn a "Commendable" rating in consumer protection standards, an indication that they had met NCQA's requirements such as handling denials and appeals fairly, coordinating medical and behavioral health care, using "prudent-layperson" standard for emergency room coverage, having sufficient access to care and giving their patients the option of consulting a third party for a resolution in an unresolved appeal. NCQA President Margaret O'Kane said, "Three years ago there probably wasn't a single plan in the nation that could have met the current NCQA definition of an 'Excellent' health plan. Now there are 40 and they deserve recognition for doing managed care right, for putting quality first." Almost a dozen Blue Cross Blue Shield plans earned a place in the top 40. Blue Cross Blue Shield President and CEO Patrick Hays said, "By raising the bar, NCQA has challenged health care plans to go above and beyond." Jay Fulkerson, president of Wisconsin's Touchpoint Health Plan, which also earned "Excellent" status, said, "This achievement provides an independent confirmation of our commitment to providing quality health care and service to our members." Of the 40 plans with the highest accreditation, 16 are in New England, and "have a long history of collaboration and accountability" (NCQA release, 10/18). Two Connecticut plans, Anthem Blue Cross and Blue Shield of Connecticut and ConnectiCare also received NCQA's high marks. Anthem's chief medical officer Robert Scalettar said, "We're very proud. We've worked hard to achieve the kind of performance that we're now able to proudly display publicly." Ida Schnipper, ConnectiCare's vice president of health services, added, "The rating provides external validation from a prestigious and recognized organization and acknowledges all the efforts that have been devoted to clinical quality, preventive health and customer service" (Julien, Hartford Courant, 10/19). To view the full press release and the complete list of "Excellent" health plans, click here.This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.