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New NCQA Standards Evaluate How Health Plans Measure Physician, Hospital Performance

Posted on: Monday, 21 November 2005, 15:00 CST

WASHINGTON, Nov. 21 /U.S. Newswire/ -- The National Committee for Quality Assurance (NCQA) today issued draft standards for "Physician and Hospital Quality," the third content area of its voluntary "Quality Plus" program. The standards focus on how health plans measure the quality and efficiency of care provided by network physicians and hospitals. Efficiency and affordability have emerged as major issues in health care, with both employers and health plans pushing for more data in these areas. Beyond simply evaluating how plans measure quality and efficiency, the standards recognize plans for using such data in pay-for-performance efforts or to help inform consumer choice. The standards also assess how plans communicate about their measurement efforts to providers, and promote collaboration between plans in order to create a robust set of data for customers and streamline reporting for doctors and hospitals.

"For any health plan, knowing which of your doctors and hospitals provide great care, and using that information to manage the health of your members, is responsibility number one," said NCQA President Margaret E. O'Kane. "These standards provide plans with tools to determine which doctors and hospitals perform at a high level, to reward and encourage them through incentives, and to steer patients to the highest-quality practices and facilities."

Plans seeking distinction in "Physician and Hospital Quality" must demonstrate that they use measures of quality and efficiency for in-network hospitals and physicians, based on a set of widely accepted performance measures and valid methodologies. Plans must also make use of clinical performance results to improve patient care -- through product design, public reporting, and by noting high- quality providers in online directories and setting realistic quality goals based upon performance data.

The performance measures used in "Physician and Hospital Quality" have received broad support from physician groups, consumer organizations, purchasers and health plans. The clinical measures of physician quality have been endorsed by the National Quality Forum (NQF) and the Ambulatory Care Quality Alliance. The hospital quality measures have gained endorsements from the NQF and the Hospital Quality Alliance.

The standards address the extent to which health plans collaborate on provider measurement. Collaboration results in a broader set of data that consumers and purchasers can use to inform choice. "As pay-for-performance programs gain traction nationwide, more and more employers are expecting health plans to measure health care performance and reward high-value care," said Suzanne Delbanco, Ph.D., CEO of the Leapfrog Group. "'Physician and Hospital Quality' helps guide health plans looking to meet this need by measuring the quality of the plan's in-network providers."

"Any successful effort to measure physician quality includes input from physicians at the outset," said Nancy Achin-Audesse, executive director, Massachusetts State Board of Medicine. "These standards require that plans measuring quality do so openly and transparently."

Physician leaders expressed their support for the measures. "'Physician and Hospital Quality' lays the groundwork for fair, equitable pay-for-performance programs," said Robert J. Margolis, M.D., chair of NCQA's Board of Directors and managing partner and CEO of HealthCare Partners, the largest physician-owned medical group in California. "They provide important protections for doctors and ensure that they have a voice in the measurement process."

One "Physician and Hospital Quality" standard will also be incorporated into NCQA's Accreditation standards for managed care organizations, preferred provider organizations and new health plans beginning in 2007. The standard assesses online provider directories for their accuracy and functionality and asks whether online provider entries include information about quality and resource use, or links to such information. This will be the only public comment period for this draft Accreditation standard.

Comments on the draft "Physician and Hospital Quality" standards are due by Dec. 19. To download the draft standards, or to submit a comment, visit NCQA's Web site at http://www.ncqa.org.

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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 manages the evolution of HEDIS, the tool the nation's health plans use to measure and report on their performance. NCQA provides health care quality information free of charge through the Web and media in order to help consumers, employers and others make more informed health care choices.

http://www.usnewswire.com

Source: U.S. Newswire

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