Program to recognize health plan innovators
The Washington, DC-based National Committee for Quality Assurance (NCQA) has released for public comment draft standards for Quality Plus, a new supplemental accreditation program it claims "breaks new ground" in content and intent.
The program is designed to highlight health plans whose innovative approaches to member communication, care management, physician compensation, and other activities are models for the industry.
The voluntary program also seeks to engage newer health plan types such as consumer-directed health plans that represent a growing sector of the health care industry.
"Quality Plus will allow us to better recognize leaders and innovators regardless of plan type," says NCQA president Margaret E. O’Kane.
"Recognizing these innovations will speed their adoption so that in the future, we’ll all be able to do things like track claims on the web, order prescription refills on-line, and get answers to our questions 24-hours a day," she adds.
The initial set of draft standards focus on how well a plan uses technology to provide members with interactive health tools and information about pharmacy benefits, claims, and health improvement. The main categories include:
- health risk appraisals;
- interactive consumer health tools;
- functionality of claims processing;
- using pharmacy benefits;
- personalized information on health plan services;
- innovations in member service.
The new standards will allow NCQA to recognize plans that lead the market in areas such as leveraging the web to promote members’ self-management of chronic conditions and allowing members to track claims on-line.
The organization initially began exploring a next-generation accreditation program in late 2003. A group consisting of 18 people representing employers, health plans, physicians, consumers, and the federal government produced comments focusing on three areas:
- ensuring all organizations meet basic customer service expectations;
- ensuring all members, regardless of health status, receive appropriate care and support to promote better health;
- standardizing performance expectations of health plans and providers.
The program was then designed with these goals in mind:
- Set the stage for a new generation of NCQA programs designed with the broad range of current health plan offerings in mind.
- Drive measurement and reporting at the physician and hospital level of the system.
- Enable consumers and employers to make comparisons between different types of plans.
Participation in Quality Plus is voluntary, and plans that meet the standards will be entitled to promote this fact in advertising and marketing materials, on their web sites, and among staff. It is strictly a pass-fail program; NCQA will not publicly report any fails.
The final standards will be released in March 2005. At that time, NCQA also expects to release the next two groups of standards for public comment: Physician and Hospital Quality and Health Improvement.
Need More Information?
For more information, contact:
• National Committee for Quality Assurance, 2000 L St., N.W., Suite 500, Washington, DC 20036. Phone: (888) 275-7585. Web site: www.ncqa.org.