In this Issue:
President's Perspective: Putting the Health Back in Health Care
It is often said that the United States is the best place in the world to get sick.
But although the American health care system is home to the most advanced health care in the world and its corps of dedicated, knowledgeable health
care professionals is second to none, our system is riddled with blind spots. Let’s start with our collective failure to insure one in seven
Americans. When you combine that with the fact that we spend twice as much on care as any other nation with quality results that vary from very good
to mediocre and down-right poor it is easy to understand why there is a clamor for reform.
The good news is that leaders from across the health care
system have come together to identify a number of these opportunities for improvement and are working hard to address them.
Through our accreditation programs and continuous
development of HEDIS® measures, NCQA has demonstrated that measurement, transparency and accountability drive real improvements in the quality
and consistency with which health care is delivered. Tens of thousands of Americans with conditions such as diabetes and hypertension are alive and
living healthier, more productive lives today as a direct result of the improvements sparked by these efforts.
It’s a terrific success story of which we can all be
proud. There’s still a great deal of work to be done but we know how to get there if we have the collective will.
We must confront the looming threat to the collective health
of Americans: namely, unhealthy lifestyles. The health challenges that derive from our increasingly sedentary lifestyles and burgeoning waistlines
threaten to swamp the gains in quality we’ve worked so hard to achieve. This also goes for our lingering smoking habit. Smoking is the leading
preventable cause of death in the United States. We’ve come a long way towards reducing tobacco use as a nation, but the number of Americans
who smoke—a little more than 1 in 5—has remained steady for the past four years.
We can, and must, do better. We need to do more to help
Americans make the right decisions on a daily basis that hold such significant sway over their health.
Simply put: We need to put the health back in health
care.
A steadily growing number of health plans, health care
organizations and forward-thinking employers, agree. Programs to promote health and wellness have proliferated in recent years. It’s an
encouraging trend: keeping people healthy is the best way to keep a lid on spiraling costs and ensure that our precious health care resources are most
efficiently directed to those in need.
The growing interest in wellness and health promotion is a
welcome signal that more and more employers are treating employee health as an asset and are taking proactive steps to safeguard the health and
productivity of workers and their families. It’s a boon for consumers, too, because what we all want out of our health care system isn’t
better health care, it’s better health.
As with any emerging trend in health care, these new health
promotion programs raise a number of questions. What’s the best approach for promoting health? What do the best wellness programs have in
common? How do I know a good health promotion vendor when I see one? What is the return on investment from such efforts?
That’s why NCQA has committed itself to bringing our
expertise in evaluation to bear on wellness and health promotion programs. Our product development staff is hard at work sifting through the evidence,
consulting with experts, and developing draft standards for a new Wellness & Health Promotion suite of accreditation and certification
programs. By evaluating health plans and vendors we can help purchasers make informed decisions about the right program to meet the
needs of their employees.
NCQA will release draft standards for the Wellness &
Health Promotion program in June. I encourage you to log on to http://www.ncqa.org/ and send us your feedback. I look forward to working with
you towards reforming our health care system—and making America the best place in the world to not just get sick, but to stay
healthy. 
Margaret E.
O'Kane
President
Evaluating Wellness Programs: A
Conversation with Patricia Barrett and Phil Renner
NCQA’s Wellness & Health Promotion Product
Suite will be released for public comment in June. Quality Matters recently sat down with Patricia Barrett, NCQA’s Vice President
for Product Development, and Phil Renner, Assistant Vice President for Performance Measurement to discuss the development of this exciting new
program.
QM: How does a health promotion program fit into NCQA’s mission of improving health care quality?
PR: The best outcome for someone who’s interacting with the health
care system is by staying healthy and not getting sick in the first place. A number of players are moving into the wellness space, and our intention
is to bring standardization and transparency to the evaluation piece, for health plans, disease management organizations, managed behavioral
healthcare organizations and standalone wellness vendors.
QM: Is there a demand for standardized measurement of these programs?
PB: Employers want to buy the best program at the best price. They have told us that NCQA can help advance this movement by developing an
objective way to measure the performance of these programs.
QM: Who could participate in this program?
PB: The key customers will be health plans and free-standing vendors. Many health plans are working with their employer customers to
create wellness programs. Other purchasers are working with vendors that offer an array of services. Our program will cover both types of
organizations.
QM: What types of services will it cover?
PB: Our market research tells us that the majority of these
organizations address such areas as weight loss, smoking cessation, physical activity, nutrition and health eating, and management of
stress. Some specialized programs focus on risky drinking and depressive symptoms. We are looking at all of these.
QM: What have you learned about what you can measure in a program like this?
PB: We will want to look at such areas as health appraisal completion rates, risk factor assessment, program participation, and risk reduction or
maintenance. The challenges are around finding the best data sources. Unlike physicians that have medical records, or health plans that have
claims data, these organizations have different types of data sources, such as self-reported data in health
appraisals.
PR: We’ve had to learn how to build a measurement approach using very different data sources than we have in the past. We’re paying
close attention to people who have specific risks, such as smoking or elevated body mass index. But we’re also looking at programs that touch
everybody, regardless of their risk profile.
QM: What’s next for this program?
PB: We have seen a great deal of consensus about where we are going, and a recognition that we want to keep pushing the industry forward. We know
this is a first generation product, but we are committed to this and think it’s the right thing to do so we are willing to work to
that.
The Wellness and Health Promotion Product Suite will be
released for public comment in June. All interested parties are invited to comment. Final program requirements will be published in January
2009.
NCQA Launches Evaluation of Medicare
Special Needs Plans
This year, NCQA will evaluate Medicare Special Needs Plans
(SNPs) under a contract with the Centers for Medicare & Medicaid Services (CMS).
In 2003, SNPs were created by Congress as part of the
Medicare Modernization Act. A new type of Medicare managed care plan, SNPs focus on certain vulnerable groups of Medicare beneficiaries, including the
institutionalized, beneficiaries with severe or disabling chronic conditions and those who are eligible for both Medicare and Medicaid (or
‘dual eligibles’). SNP members are typically older, with multiple co-morbid conditions, and are more challenging and costly to treat.
SNPs offer the opportunity to improve care for special needs patients primarily through improved coordination and continuity of
care.
At CMS’ request, NCQA has developed a phased
evaluation approach that includes collection of SNP-specific HEDIS measures and a set of structure and process (S&P) measures that are based on
existing NCQA health plan standards. In subsequent years, NCQA will incorporate new SNP-specific HEDIS and S&P measures and progressively raise the
bar.
To help SNPs
prepare for these evaluations, NCQA conducted a series of online trainings on five key areas of the SNP evaluation program in March and April.
Representatives of SNP plans were able to ask questions about the
evaluation requirements and the process for submitting data through NCQA’s data collection systems.
More than 470 SNPs are required to report to NCQA by June
30, 2008. In 2009, almost 800 SNPs are expected to submit data.
A listing of S&P measures, and further SNP reporting
requirements can be found at NCQA’s newly launched SNP Web page.
NCQA’s 2008 Health Quality Awards
Celebrate Achievements of 4 Leaders and Innovators
On the
evening of April 1, NCQA honored four health care advocates who have shown leadership in the effort to bring meaningful reform to our health care
system. The achievements of Senator Edward M. Kennedy (D-Mass.), Governor Arnold Schwarzenegger (R-Calif.), King County (Wash.) Executive Ron Sims and
Arkansas Surgeon General Joseph Thompson were recognized at a dinner and awards ceremony in Washington, D.C.
The NCQA Health Quality Awards dinner and ceremony
brought together a diverse and powerful group of health care stakeholders, including health plans, employers, patients, caregivers, pharmaceutical
industry leaders and leading policy makers from Capitol Hill and the Bush Administration.
In accepting his award, Executive Sims passionately pleaded
with the audience to help reduce the disparities in quality, cost and access for minorities and poor Americans. To affect real change in
today’s America, he believed there is an increasing need for collaboration between health care stakeholders. Sims cited his experience in
leading the Puget Sound Health Alliance to improve health care quality and reduce cost growth in Washington State’s most populous
county.
Dr. Thompson spoke to the crowd about his work to reduce
obesity in school-age children in Arkansas. A key to that success was collaboration with non-traditional players such as school nurses and school
cafeterias.
Accepting the award on behalf of Governor Schwarzenegger,
Cindy Ehnes, Director of California’s Department of Managed Health Care, said that the uninsured deserve more attention and said the Governor
remains committed to finding ways to cover all Californians. Dr. Kavita Patel, Deputy Health Staff Director for Senator Kennedy’s Committee on
Health, Education, Labor and Pensions, said the Senator is pursuing health reform at the national level that will make coverage a right for all
Americans.
Visit http://www.ncqa.org/ for more information and photographs from the 2008 Health Quality
Awards event.
NCQA Awards 10,000th
Physician Recognition
In April, NCQA reached a major milestone when it awarded its
10,000th physician recognition for high quality care. Since 1997, NCQA has offered doctors the opportunity to be evaluated and recognized
for high performance in such areas as diabetes, cardiovascular conditions, back pain, and for using systematic processes to improve patient
care. These programs are also used by health plans and employers as part of pay-for-performance programs across the country.
Of the 10,000 recognitions, California leads the
way with more than 2,500 NCQA-recognized physicians. Over half of those physicians are recognized through the NCQA Physician Practice
Connections® program. North Carolina, Massachusetts, New York and Pennsylvania round out the top five states with NCQA-recognized
physicians.
Since the introduction of the first recognition program in
1997, patients, employers and health plans have come to rely on the programs as a basis upon which to identify and reward top-performing practices.
They have also served as a valuable practice improvement tool for physician practices. NCQA currently recognizes physicians in five programs. They
are:
- Diabetes Physician Recognition Program (DPRP), co-sponsored
by the American Diabetes Association,
- Heart/Stroke Recognition Program (HSRP), co-sponsored by
the American Heart Association/American Stroke Association,
- Back Pain Recognition Program (BPRP),
- Physician Practice Connections (PPC) and
- Physician Practice
Connections—Patient-Centered Medical HomeTM (PPC-PCMH).
NCQA recently released an online video
highlighting our Physician Recognition programs, providing information to employers, plans and physicians about the value and benefits of NCQA
Recognition. To view the video and for more information about NCQA’s programs, visit www.ncqa.org/recognition.aspx. To find Recognized physicians in your area, use NCQA’s Recognition search engine at
http://recognition.ncqa.org/.
2008/2009 NCQA
Publications and Products Available for Pre-Order in May
Watch your mailboxes
for NCQA’s 2008 Quality Compass brochure, 2008/2009 Publications and Product
Catalog and the Fall 2008 Education Planner. Preorders for Quality Compass 2008
are available now; NCQA Accreditation and HEDIS publications and products will be available for preorder in mid-May.
For more information,
contact NCQA Customer Support at 888-275-7585 or customersupport@ncqa.org.
