| Managed Care On-Line News: Articles |
FOR RELEASE
June 19, 1996
NCQA RELEASES FIRST GROUP OF
ACCREDITATION SUMMARY REPORTS
Reports provide more detail on accreditation decisions;
show health plan performance in six key areas
WASHINGTON -- The National Committee for Quality Assurance (NCQA) today released the first group of Accreditation Summary Reports (ASRs), which provide more detailed information on individual health plan accreditation decisions. The ASRs -- released initially for 48 health plans -- provide consumers and purchasers with more information about how individual health plans fared in their NCQA accreditation reviews.
"Our mission is to put information about health plan quality into the hands of purchasers and consumers to help them make informed choices," said Margaret E. O'Kane, NCQA President. "With the ASR, we have packaged that information in easy-to -read graphics that summarize the plan's compliance with our standards."
An ASR is a two-page synopsis of a health plan's in-depth, technical NCQA accreditation report. The technical reports, which may run into hundreds of pages, are used as the basis for determining NCQA accreditation status. "Up until now, we have simply released a given plan's overall status -- full accreditation, one-year, provisional, or denial," said Karen Goldstein, NCQA Vice President for Accreditation. "But consumers and purchasers have told us that they want to know specifically how plans fared in particular areas."
To that end, each ASR will show the plan's scores relative to a national average in the six broad areas of NCQA's Accreditation Standards: Quality Management and Improvement; Members' Rights and Responsibilities; Physician Qualifications and Evaluation; Preventive Health Services; Utilization Management; and Medical Records. In instances where two or more competing health plans have the same overall accreditation status, this information will let consumers and purchasers know each plan's specific strengths and weaknesses.
To further aid purchasers and consumers, ASRs will also indicate the various names under which the health plan is marketed, the type of delivery system (e.g., IPA or staff model), number of enrollees, year established, and type of business (e.g., for-profit).
By contrast, the Accreditation Status List (ASL), first released in June 1994, is a list of all health plans that NCQA has granted decisions to, showing only their overall accreditation status. The list also includes plans awaiting decisions and those scheduled to go through the review process.
"To the extent that the ASRs show what underlies a plan's accreditation ranking, they will make a significant contribution to consumers' ability to choose a plan that best suits their needs," said Carol Cronin, Senior Vice President, Health Pages, "as well as to their understanding of what accreditation is all about."
Initially, ASRs will be available for 48 health plans. Plans reviewed prior to July 1, 1995 were reviewed under the previous set of standards and therefore could not be included. However, over the next three years, as more plans go through the process for the first time and as plans come up for review again, that number should grow to include every HMO NCQA reviews. NCQA expects approximately 8-10 new ASRs to become available each month.
Since the ASR prototype was released last September, plans undergoing reviews have received copies of their own ASR (without comparison to the average) for review. Industry response has been positive. "The more information we provide to consumers the better," said Charles Cutler, M.D., Vice President, Medical Services, Prudential HealthCare. "By showing consumers our strengths, the ASR validates the substantial efforts we put into quality improvement and external objective review by NCQA."
Working with focus groups consisting of consumers, purchasers and health plans, NCQA developed and tested the ASR over the past year. As the prototype ASR was completed and released last September, NCQA also made public the scoring methodology used to inform accreditation decisions. While that methodology stands to be updated in early 1997, a description of the current system is available from NCQA upon request.
Consumers can receive the reports for $3 each through NCQA's Publications Center (800) 839-6487. The reports are available free of charge on NCQA's World Wide Web site (http://www.ncqa.org).
For the first time, NCQA will also offer subscriptions to the ASL and ASRs for those seeking regular updates on accreditation information. The subscriptions will provide monthly updates of the ASL and ASRs, as well as other NCQA publications.
The ASL will be revamped next month in order to make it easier for both purchasers and consumers to understand. The revised ASL will list all names a plan is marketed under, and whether an ASR is available for the plan. It will also be organized in a more user-friendly manner. The new state listing will include all plans that offer coverage in each state, as opposed to only including plans that were incorporated in a state.
A non-profit watchdog organization, NCQA is widely recognized as the leader in the effort to assess, measure and report on the quality of care provided by the nation's managed care organizations. About half of the nation's HMOs have been reviewed as part of NCQA's accreditation process.
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