In this Issue:
President's Perspective: Making Quality More Than Its Own
Reward
The way we pay for health care - reimbursing visits and procedures in a piecework
fashion - has had far-reaching, if unintended, consequences on the practice of American medicine. What's most striking about our health care
reimbursement system is its insensitivity to quality. While just about everyone expresses a willingness to pay more for top-notch care, the reality is
our payment system sends the opposite message: Do more and get paid more.
One of the most significant developments to emerge over the past three years is the broader measurement of physician
performance by health plans and others with an eye towards tiering networks by quality and/or cost. Some of these efforts have flourished, while
others have hit snags as the field of physician and hospital measurement continues to evolve.
Payors and providers have engaged in spirited debate about whether, how and how much to
measure. A broad group of employers and consumer advocates - notable among them the Consumer-Purchaser Disclosure Project - have weighed in to lead
the call for objective, usable information. And public officials, including New York Attorney General Andrew Cuomo, have stepped in to set ground
rules for the use of physician measurement and network tiering. Other states are closely watching these developments as they consider taking action of
their own.
NCQA has been at the forefront of evaluating physician measurement efforts. In 2005, we
released the first edition of Physician and Hospital Quality,a voluntary supplement to NCQA Accreditation for health plans. Since then, more than 60
organizations have stepped forward to be evaluated. NCQA has now updated this program to make it available to more entities and to account for
developments in the field (see story below).
Our experience has taught us that there's a right way and a wrong way to go about
physician measurement.
First, physicians cannot be measured on the basis of cost alone: cost measures only
identify which doctors are the cheapest - not the highest quality or most efficient. Cost alone is not an indicator of clinical quality. Accordingly,
physicians must be measured on quality, or quality and cost, for any measurement or tiering initiative to be valid.
Second, physicians must also have a clear idea of how they are being measured so that
they can develop and refine quality improvement initiatives. They should be graded based on standardized measures, where possible, to reduce
measurement burden and to help make results more consistent in areas where physicians are involved in multiple measurement efforts.
Third, markets abhor a vacuum, and health care is no different. If we do not provide
usable, equitable performance data to inform physician choices, opinion will take its place. That's why professional societies are entering the
discussion to ensure that their perspective is heard.
Finally, no decision a patient makes will influence their health outcomes so much as
their choice of a doctor. If patients make this decision with objective, usable information on physician performance - either getting information
through a Web site or taking advantage of a lower copay offered by their health plan - they will serve as a powerful driver of improvement, and align
our desires for higher-performance health care with the signal we send with our checkbooks.
Margaret E.
O'Kane
President
New Physician & Hospital Quality Certification
Standards Released
NCQA has updated our Physician & Hospital Quality (PHQ) program, which
evaluates efforts to measure and report the quality and cost of physicians and hospitals.
PHQ, the first program to independently assess provider measurement, was
developed by NCQA in 2006 as part of the voluntary Quality Plus program suite. It has been offered to NCQA-Accredited plans seeking the opportunity to
earn further distinction for their efforts. More than 60 health plans earned the PHQ seal.
The updates to the program reflect changes in the provider measurement
field, as well as feedback from purchasers, regulators and physicians. Perhaps the biggest change is that PHQ is now a stand-alone NCQA Certification
program, open to any organization including accredited and unaccredited health plans, measurement collaboratives, provider networks and Web
sites.
PHQ Certification is based on four key principles:
- Standardization and sound methodology. Results must be compared across
organizations.
- Transparency. Organizations must offer physicians the opportunity to
provide input on measurement programs and provide clear, understandable information about how the results will be used.
- Collaboration. Where possible, organizations should pool their data on
standardized measures to produce results with greater statistical reliability.
- Action on quality and cost. Organizations must measure on the basis of
quality or quality and cost, but never on cost alone.
Notable changes to the standards include the required use of
standardized, third-party measures, the involvement of providers during the program development process and the use of quality measures when acting on
measurement results.
For more information about the program, including survey options and
types, click here.
Quality at a Crossroads: Five-Point
Agenda for Quality Improvement
Health care quality improvement is essential to controlling costs and expanding coverage. But with health care costs
rising amidst a stalled economy, quality improvement is too often set aside in favor of cost reduction.
NCQA President Margaret E. O'Kane joined National Quality Forum CEO Janet Corrigan and a group of health care thought
leaders to propose a nonpartisan reform plan that links cost and quality together to improve health care for all Americans. Their proposals were
detailed in the May/June issue of Health Affairs, one of the nation's leading health policy journals.
The Quality Crossroads Group addressed the complex challenges confronting the U.S. health care system in a five-point
agenda. The agenda serves as a vision for quality and puts it on a par with access to care and rising costs--which are the issues that tend to grab
headlines in an election year.
The five-point reform plan put forward by the group's 13 authors would create meaningful change in the current health
care system if adopted by the next President. The reform plans call for:
- A national center to support effectiveness research,
- Models of accountable health care entities capable of providing integrated and coordinated care,
- Payment models that reward high-value care,
- A national strategy for performance measurement, including standardized measures of patient and population health, and
- A multistakeholder approach to improving population health.
To read more about the plan for reform, click here to view the Health Affairs article at no cost.
NCQA, U.S.News & World Report to Release
America's Best Health Plans 2008 Rankings This Fall
For the fourth consecutive year, NCQA and U.S.News &
World Report will collaborate to produce America's Best Health Plans, the only national ranking of health plans based on performance.
Each year, millions of Americans use this information to make sound decisions when choosing their plan during open enrollment season.
As in past years, this edition of America's Best
Health Plans will include rankings of the nation's top 50 commercial health plans based on their combined performance on HEDIS, CAHPS and NCQA
Accreditation standards. The issue will also feature lists of the nation's top 25 Medicare and Medicaid plans.
Complete rankings of all plans will appear on the
U.S.News Web site. Visitors to usnews.com will be able to view health plans' HEDIS scores in selected areas of care and make comparisons
between and among plans. The feature will appear in the November 10 issue of U.S.News, which will hit newsstands on Monday, November
3.
Additional information--including a complete methodology
and marketing guidelines--are available at www.ncqa.org/bestplans.aspx. Updates will be sent to health plan contacts and posted to the Web.
Contact NCQA Customer Support at 888-275-7585 should you
have further questions.
NCQA Annual Report Focuses on Medical
Home 
NCQA's 2007 annual report, Coming Home to Better Care, is now available at http://www.ncqa.org/. This year's report
closely examines the concept of the patient-centered medical home. This model of care holds great promise for combating the trends in our health care
system towards greater fragmentation and proposes a better-coordinated continuous healing relationship between doctor and patient. In January, NCQA
issued a set of standards describing the types of functions medical practices must perform to qualify as a medical home.
The Annual Report gathers the insights of a number of health
care thought leaders, including:
- Paul Grundy, M.D., MPH, FACOEM, FACPM, Director of Healthcare, Technology and Strategic Initiatives for IBM Global Wellbeing Services and
Health Benefits and Chairman of the Patient-Centered Primary Care Collaborative
- Karen Davis, President of The Commonwealth Fund
- John Tooker, M.D., MBA, FACP, Executive Vice President and Chief
Executive Officer of the American College of Physicians
- Xavier Sevilla, M.D., FAAP, a Florida pediatrician who
re-engineered his office and care delivery systems from the ground up to incorporate the principles of the Patient-Centered Medical
Home.
The report also briefly touches upon NCQA's current efforts to
develop a program to assess wellness and health promotion programs. To read the full report, click
here.
NCQA Continues
Development of HEDIS Relative Resource Use Measures
Last year, Americans spent more than $2 trillion on
health care. But the care that they receive in return continues to be of uneven quality.
To help assess the value added by health plans, NCQA
fielded a new set of standardized measures of Relative Resource Use (RRU).
RRU measures focus on six costly chronic conditions:
diabetes, acute low back pain, asthma, chronic obstructive pulmonary disease (COPD), uncomplicated hypertension and cardiovascular conditions.
Together, these conditions account for 60 percent of all private health care spending. When RRU measures are used in concert with HEDIS measures, the
results provide a clearer picture of how much health Americans are getting for their health care dollar.
With two years of data, NCQA is examining ways to
further the usefulness of these eye-opening measures. NCQA is looking at how health plans' RRU results vary from one year to another and whether
health plans perform similarly among different RRU areas. These studies will help discern changes in the data over time, as well as identify trends in
resource allocation among health plans.
NCQA will also field-test a more rigorous risk
adjustment approach to RRU measures. This approach will ensure that health plans with sicker patients do not get penalized for utilizing more
resources. NCQA will also look into how this methodology could be applied to systems besides health plans.
RRU measures highlight the inefficiency and waste that
permeates today's health care system. NCQA is committed to raising the quality of care, while also increasing its efficiency to help make health care
more accessible and affordable to all Americans.
NCQA Policy Conference to Examine Cost
and Quality in Health
As election season enters full swing, the topic of
health care is prominent in policy discussions: spiraling health costs, the swelling ranks of the uninsured and mounting evidence of uneven
performance in the U.S. health care system are grabbing headlines and the attention of voters. Both major-party candidates are positioning themselves
as change agents. The current political climate affords health care stakeholders a unique opportunity to bring lasting, significant reform to the
health care system.
On December 5, 2008, NCQA's third annual Policy
Conference will assemble leading health experts from across the nation to scrutinize options that hold the potential to lower costs and improve care.
At the conference, leading experts will present the latest research, theories and marketplace case studies, and engage the audience in a two-way
dialogue. Coming a month after this year's national elections, the conference will provide an opportunity to hear from the incoming Administration
about their plans for health reform. Click here to register and learn more about NCQA's
Policy Conference. Be sure to register early as space is limited!
Quality Compass 2008: Order
Today!
Understand plan performance. Track quality improvement. Analyze industry trends.
Quality Compass 2008 is scheduled for release at the end of July. New features for this year's
version include performance data from individual PPO health plans, and a Medicaid trending feature that allows users to
track HEDIS performance among Medicaid plans from 2007 on.
Order your edition of Quality Compass today by clicking here or contacting NCQA Customer Support at (888)
275-7585.
Mark of Quality Has a New
Look
Updated Seals
Available for Download at NCQA.org
NCQA has updated the seals organizations may use
to advertise their accreditation, certification and recognition status. The seals are a crisp and clean reflection the new NCQA brand and
colors. The seals can be downloaded in four formats at www.ncqa.org/marketing.aspx.
Organizations are asked to replace NCQA seals on Web sites or other electronic media as soon as
possible. Although organizations are not required to immediately replace seals on printed materials, NCQA asks organizations to be proactive in
replacing seals when materials are redesigned or reordered. As a reminder, organizations using any NCQA seal must adhere to NCQA Advertising Guidelines. Additionally, any materials
advertising an NCQA program or product must be submitted to the Marketing Department at marketing@ncqa.org.
Discover NCQA Programs This Fall
NCQA Education offers fall seminars to help organizations
meet their quality goals. This is a unique opportunity to learn the essentials of key NCQA programs and systems ranging from HEDIS best practices to
Health Plan Accreditation updates. Most events fill well in advance; reserve your space as early as possible!
Introduction to HEDIS for MCOs and
PPOs
September 15-16, 2008 | San
Francisco, Calif.
Learn how to collect HEDIS data and how
to use the data for maximum benefit to your organization.
HEDIS® Update and Best
Practices
September 17-18, 2008 | San
Francisco, Calif.
October 21-22, 2008 | Alexandria,
Va.
An extensive review of new HEDIS
measures, a review of changes to existing measures and a look at future areas of HEDIS measurement.
Update on Health Plan Accreditation
September 19, 2008 | San Francisco,
Calif.
October 23, 2008 | Alexandria,
Va.
Understand the latest Health Plan
Accreditation standards changes and how to prepare to meet them.
NCQA Disease Management & Complex Case
Management
October 24, 2008 | Alexandria,
Va.
Discover disease management standards
and the distinction between and the interrelationship among the disease management, case management and continuity and coordination of care
standards.
Visit www.ncqa.org/education for an expanded calendar with detailed information behind each
seminar.
NCQA Education also offers these and other programs as
corporate trainings at organizations' headquarters. Click here
for more details.
NCQA to Conduct Back Pain Care Workshop at NASHO
NCQA is co-sponsoring the National Association of Specialty Health Organizations (NASHO) 6th Annual Leadership Summit on
Specialty Health at the Wynn Las Vegas on October 21-22, 2008.
NCQA will present an industry workshop on back pain care and treatment on Tuesday, October 21. The
workshop will feature information about our Back Pain Recognition Program (BPRP) and how payers are using it to identify high-performing clinicians
for tiered networks and pay-for-performance programs.
If you you're interested in learning more about BPRP and would like to join us in Las Vegas, you can register at http://www.nasho.org/events.html. For more information about NCQA's Recognition Programs view
an on-line video here.
July and August: The Hot Season for New NCQA
Publications
NCQA will be releasing a several key updates publications in July and August. The following items are available for pre-order
now:
-
HEDIS 2009, Volume 1: Narrative
-
HEDIS 2009, Volume 2: Technical Specifications
-
2009 Health Plan Standards and Guidelines
-
2009 Health Plan Survey Tool
-
2008 Physician and Hospital Quality Survey Tool
-
2009 NHP Standards and Guidelines
-
2009 NHP Survey Tool
-
Quality Compass 2008
For more information, visit http://www.ncqa.org/publications or contact NCQA Customer Support at
888-275-7585.
