The Washington, DC-based National Committee for Quality Assurance (NCQA) says that 39 health plans nationwide, collectively covering more than 11.5 million Americans, have committed to undergo surveys under the first of set of NCQA’s new "Quality Plus" standards — Member Connections.
These standards focus on the depth, accuracy, and interactivity of the information health plans provide their members in order to best help them manage their own health.
Member Connections is the first step in NCQA’s effort to update its accreditation programs, so that the same standards apply to a broader array of plan types.
The standards assess how effectively an organization interacts with its members via the web and telephone to help them understand benefits, access self-management tools for certain conditions, and check the status of their claims.
Effective engagement of consumers and patients in these ways, coupled with quick, clear responses to inquiries from plan enrollees, can have a dramatic impact on member satisfaction.
The final standards for Member Connections will be released at the end of January; surveys will begin on July 1.
"We want to make it easier for our members to make well-informed decisions about their health care. That includes helping them understand their benefits, and helping them learn how to stay healthy," explains Dominic Galante, MD, vice president, medical quality management for Preferred Care of Rochester, NY.
Large employers helped develop the new standards and many are expected to require health plans serving their employees to seek the additional distinction of meeting them.
Among the large employers expressing support for the new standards were NCR Corp., Verizon, and the Pacific Business Group on Health.
The Quality Plus program is a voluntary component of NCQA’s Accreditation programs for HMOs, PPOs, and point-of-service plans. Its purpose is to identify those organizations that provide information about the quality of physicians and hospitals, help members make decisions about their own health, take innovative approaches to chronic condition management, and keep their members healthy.
Quality Plus standards are designed to provide consumers and employers with a basis for comparing different types of plans, including HMOs, PPOs, and consumer-directed health plans. Large employers and consumer groups have endorsed the program.
Standards for two other new content areas, Physician and Hospital Quality and Health Improvement, will be released for public comment in March.
Plans that meet the standards in any or all of the three Quality Plus content areas will be recognized on NCQA’s Health Plan Report Card, available at www.healthchoices.org.
Plans also will receive a seal acknowledging their distinction in the Member Connections program for placement on their web site.