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Employers, Unions, Consumer Advocates Endorse New NCQA Health Plan Accreditation Standards

Posted on: Wednesday, 1 August 2007, 15:06 CDT

Preferred provider organizations (PPOs), which cover nearly two-thirds of all privately insured Americans, will be required to report on the quality of care and service their members receive under standards released today by the National Committee for Quality Assurance (NCQA). All health plans -- including HMOs and PPOs -- will be evaluated under the same set of standards. A broad cross-section of 41 employers, labor unions and consumer advocates endorsed the new standards [see attached list].

Americans spend almost twice as much per capita on health care as other industrialized nations, but often receiver lower quality care. For more than a decade, NCQA has measured and publicly reported the quality of care delivered by HMOs through its Healthcare Effectiveness Data and Information Set (HEDIS®), the most widely used measure of quality in the nation. Plans that measure and publicly report their quality data routinely outperform those that do not, saving lives and reducing costs.

Under the new Health Plan Accreditation standards released today, PPOs seeking NCQA Accreditation will be required to report clinical quality results through HEDIS. While nearly 150 million Americans are enrolled in a PPO, most such plans do not collect and report quality data. In 2006, 80 PPOs submitted HEDIS data to NCQA; a similar number are expected to do so this year.

Evaluating health plans on a common set of standards will allow consumers, employers and other purchasers of health care to easily compare the performance of all plans and make the choices that best fit their needs. "PPOs cover 150 million Americans, yet we know disturbingly little about the quality of care they deliver," said NCQA President Margaret E. O'Kane. "In order for employers and families to make good comparisons and informed choices, it only makes sense to build upon the success we've had in measuring the quality of managed care organizations by asking PPOs to do what HMOs have done for years."

Major U.S. employers welcomed the new standards and promised to ask their plans to become NCQA Accredited. "At 3M, we think of what we spend on health care benefits as an investment in health rather than an investment in health care," said Jack Arland, North America Benefits Manager, 3M. "We need to know which plans are best at protecting and improving our employees' health, and HEDIS results are a good indicator. That's why we strongly support the new standards, and we plan to ask all the PPOs we do business with to pursue NCQA Accreditation."

Benefit consultants also lauded the new standards. "Employers know that a healthy, productive workforce is a tremendously valuable asset," said Ted Nussbaum, director of group and health care consulting in North America, for Watson Wyatt Worldwide, one of the world's leading consultants on people and financial issues, including employee benefit programs. "Now that PPO plans have shown that it's possible to report HEDIS data, employers can begin to ask plans that don't currently do so to start - it's a very direct way of demonstrating a plan's added value and showing how well a plan helps protect employee health."

Health policymakers in Washington and around the country have recognized the need for more widespread quality reporting by PPOs. The Medicare program and the Federal Employees Health Benefits Program now require PPOs to report HEDIS data. In August 2006, President Bush issued an Executive Order directing U.S. agencies to advance an agenda of quality and price transparency in health care and U.S. Health and Human Services Secretary Michael Leavitt has been working with communities around the country to advance a value-based purchasing agenda that includes quality reporting and transparency.

For more information about NCQA's new Health Plan Accreditation Standards, visit www.ncqa.org. PPO plans interested in becoming Early Adopters of the new standards are encouraged to contact Jeannie Simpson, Director of Customer Outreach, at (202) 955-5137.

NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations and recognizes physicians in key clinical areas. NCQA's Healthcare Effectiveness Data and Information Set (HEDIS) is the most widely used performance measurement tool in health care. NCQA is committed to providing health care quality information through the Web, media and data licensing agreements in order to help consumers, employers and others make more informed health care choices.

ORGANIZATIONS ENDORSING 2008 ACCREDITATION STANDARDS

3M

AFL-CIO

American Hospice Foundation

Bridges to Excellence

Business Health Care Action Group

CBS Corporation

Center for Medical Consumers

Childbirth Connection

Citizen Advocacy Center

Colorado Business Group on Health

Consumers Advancing Patient Safety

Consumers' CHECKBOOK/Center for the Study of Services

Consumers Union

DaimlerChrysler Corporation

Eastman Chemical Company

Families USA

Ford Motor Company

General Electric Company

General Motors

Health Care For All

Independence Blue Cross

Kennametal Inc.

Marriott International

Maureen Cotter & Associates

Memphis Business Group on Health

MidAtlantic Business Group on Health

National Business Coalition on Health

National Business Group on Health

National Coalition for Cancer Survivorship

National Consumers League

National Partnership For Women and Families

New York Business Group on Health

Pacific Business Group on Health

Pfizer, Inc.

Pitney Bowes

SEIU

St. Louis Area Business Health Coalition

The Leapfrog Group

UPS

Watson Wyatt Worldwide

Xerox

Source: Business Wire

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