Health Plan Certification Requires Care Quality
The National Committee for Quality Assurance (NCQA) plans to require that health insurance plans who apply for accreditation include measures to report on the quality of care that patients receive, as reported by the Managed Care Information Center. This initiative will apply to all health plans, including preferred provider organizations (PPOs). All plans will be evaluated according to the same set of measures about patient experience, clinical measures, and care standards.
The organization will also require that accreditation applicants utilize their reporting measure, the Health Plan Employer Data and Information Set (HEDIS) and the Consumer Assessment of Healthcare Providers and Systems (CAHPS). The current scoring system for plan accreditation from NCQA uses the combined scores to formulate thirty percent of the overall score given to the plan. The group intends to increase the portion of the score comprised from these measures to fifty percent within the next year.
NCQA provides performance evaluation of health plans nationwide, allowing consumers to opt for the program which best suits their needs based on reliable and objective evaluation. Two federal health insurance programs, Medicare and the Federal Employees Health Benefits Program, both require reporting with HEDIS already.
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July 11, 2007 Related topics: Evaluation & assessment, Cost savings