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At least 19 recordsLinked to original sources
PubMed2002

The search for value in health care: a review of the National Committee for Quality Assurance efforts.

Large employers formed the National Committee for Quality Assurance (NCQA) to ensure value to healthcare purchasers. Value in healthcare is a function of quality divided by costs. Through NCQA's role as an accrediting agency for healthcare organizations and the development of performance measures, Health Plan Employer Data and Information Set (HEDIS), gains toward defining the value of health services have materialized. An analysis of the impact of HEDIS data collection on physician practices and the influence of HEDIS data on employer, employee, and governmental health plan selections is examined. This study consisted of a general review, from 1993 to 2001, of HealthStar databases, PubMed databases, and the NCQA website. NCQA accreditation is accepted as an important industry milestone for health plans, credentials verification organizations, and physician organizations. The data for HEDIS is collected from health plan administrative data repositories, whereas health plan members' clinical data may be collected by chart abstraction in physician offices. Data collection in physician offices consumes administrative resources from physician practices and health plans. As commercial and governmental insurers move toward greater adoption of HEDIS measures, complex implications are created for physician practices and vulnerable populations. There are lingering questions regarding the improvements in quality of care for medically underserved populations and physician practice costs attributable to HEDIS.

Accreditation↗
PubMed1997

Improving the quality of the NCQA (National Committee for Quality Assurance) Annual Member Health Care Survey Version 1.0.

The National Committee for Quality Assurance (NCQA) developed a standardized survey instrument in 1995 designed to measure enrollee satisfaction with the care and services received from health plans across the United States. After the survey was administered for a large number of health plans and thousands of responses were received, some areas for survey improvement have emerged. The objective of this research was to evaluate the NCQA Annual Member Health Care Survey Version 1.0 (the standard form) relative to an alternate survey form created in cooperation with the HMO Group, Maritz Marketing Research, Inc., and Healthcare Research Systems, Ltd. The alternate form of the NCQA survey was constructed to test several theories of measurement improvement via rewording of items, reordering of items, deletion of items, and addition of items. The most important findings of the research project are reported herein. Ten geographically dispersed member health maintenance organizations (HMOs) of The HMO Group took part in the project. A split-half design was used to test the standard and alternate survey forms concurrently. Surveys were administered by using the NCQA-recommended mail methodology of survey and cover letter, reminder card, and second survey. Assuming a 50% response rate, a target of 400 responses (200 for each survey form) per HMO was planned. The window for responding was allowed to remain open 4 weeks beyond the mailing of the second survey to achieve the desired response rate. A total of 4,056 responses were collected (2,022 for the standard form and 2,034 for the alternate form). It was found that the addition of "No Experience" and "No Opinion" response options to the majority of satisfaction items reduced the random error associated with informed responses and produced statistically significant higher correlations with the global satisfaction items relative to the standard form items. Only four of the eight Short Form 12 summary scales, General Health, Reported Health Transition, Mental Health, and Social Functioning, were useful for adjusting data (covariation). The entire set of comorbidities (chronic disease checklist) could be eliminated without losing significant data adjustment capability. The multiple linear regression models generated by using the global satisfaction items on the alternate form had higher adjusted R2 values than the standard-form models. The alternate-form item Overall Value correlated highly with cost items and general satisfaction item, making it a useful global satisfaction variable for predictive modeling.

Health Care Surveys↗
PubMed1999

Accreditation by the National Committee on Quality Assurance (NCQA): a description.

The objective of this article is to describe the National Committee on Quality Assurance (NCQA). The NCQA is one of many organizations that is addressing the issues of quality assurance of health care for HMOs. It is of concern that when HMOs focus on cost they may stint on services. Also it is difficult for HMOs to compete for both quality and cost if there is not a comparable objective standard of measurement. The NCQA offers a level of accreditation that is representative of organizational structure and resources. The Health Plan Employer Data and Information Set (HEDIS) is used to compare outcomes and professional resources. The results of both the accreditation and the HEDIS measures are compiled in a national data base, The Quality Compass. There is skepticism that the NCQA is measuring the correct data for basing quality measurement decisions and also the data obtained is severely underutilized by health care purchasers (employers with less than 1,000 employees).

Accreditation↗
PubMedDate not supplied

Enhancing performance measurement: NCQA's road map for a health information framework. National Committee for Quality Assurance.

Measuring the quality of health care delivery is one of the most critical challenges facing US health care. Performance measurement can be used to track the quality of care that health plans and medical groups deliver, but effective performance measurement requires timely access to detailed and accurate data. In 1996, the National Committee for Quality Assurance (NCQA) commissioned a report to learn what actions would improve health plans' capacity to electronically report performance data for the Health Plan Employer Data and Information Set (HEDIS). Tracking clinical performance will require not just clinical data stored in information systems, but an integrated health information framework. Seven features are essential to this framework: (1) it specifies data elements; (2) it establishes linkage capability among data elements and records; (3) it standardizes the element definitions; (4) it is automated to the greatest possible extent; (5) it specifies procedures for continually assessing data quality; (6) it maintains strict controls for protecting security and confidentiality of the data; and (7) it specifies protocols for sharing data across institutions under appropriate and well-defined circumstances. Health plans should anticipate the use of computerized patient records and prepare their data management for an information framework by (1) expanding and improving the capture and use of currently available data; (2) creating an environment that rewards the automation of data; (3) improving the quality of currently automated data; (4) implementing national standards; (5) improving clinical data management practices; (6) establishing a clear commitment to protecting the confidentiality of enrollee information; and (7) careful capital planning. Health care purchasers can provide the impetus for implementing the information framework if they demand detailed, accurate data on the quality of care.

Forms and Records Control↗
PubMed2002

National Committee on Quality Assurance health-plan accreditation: predictors, correlates of performance, and market impact.

CONTEXT: Accreditation of health care organizations has traditionally been considered a building block of quality assurance. However, the differences between accredited and nonaccredited health plans and the impact of accreditation on plan enrollment are not well understood. OBJECTIVES: To determine the characteristics of plans that have submitted to accreditation review, the performance of accredited plans on quality indicators and the impact of accreditation on enrollment. DESIGN: The databases containing 1996 data on health plans' National Committee on Quality Assurance (NCQA) accreditation status, organizational characteristics, Health Plan Employer Data and Information Set (HEDIS) scores, and patient-reported quality and satisfaction scores were linked to compare accredited health plans to nonaccredited plans. We also combined longitudinal data sets (1993-1998) on accreditation and health plan enrollment. MAIN OUTCOME MEASURES: Mean performance of accredited and nonaccredited plans on HEDIS measures and patient-reported measures of quality; health plan enrollment changes. RESULTS: Accredited plans have higher HEDIS scores but similar or lower performance on patient-reported measures of health plan quality and satisfaction. Furthermore, a substantial number of the plans in the bottom decile of quality performance were accredited suggesting that accreditation does not ensure high quality care. Receipt of accreditation has been associated with increased enrollment in the early years of the accreditation program; however, plans denied NCQA accreditation do not appear to suffer enrollment losses. CONCLUSION: NCQA accreditation is positively associated with some measures of quality but does not assure a minimal level of performance. Efforts now underway to incorporate plan performance on HEDIS into criteria for accreditation seem warranted.

Accreditation↗
PubMedDate not supplied

Ensuring health care quality: perspective from a member of NCQA's Committee on performance measurement. National Committee on Quality Assurance.

Using the California Public Employees' Retirement System (CalPERS) as an example, this paper illustrates how an employer can abandon the more traditional role of passive purchaser of health care benefits and become an active participant in cost containment and quality improvement in the health care industry. Through the use of the Health Plan Employer Data Information Set (HEDIS) 3.0 and other data collection and reporting methods, the communication gap between consumers, purchasers, health plans, and providers is narrowing. Increasingly, purchasers like CalPERS are becoming involved in quality improvement; they are recognizing the need to serve as intermediaries between consumers and health plans, to understand available data, and to disseminate that information to the consumer. The purchaser's impact on the health care community's business practices is growing. As a result, the collection and reporting of HEDIS data are now emerging as substantial fiduciary reporting responsibilities for health plans. This paper outlines a plan implemented in California for improving HEDIS data gathering and examines surveys, results, and problems encountered in improving and integrating health care information.

Humans↗
PubMed1998

An introduction to the National Committee for Quality Assurance.

The corporations that purchase private health benefits and the public payers, Medicare and Medicaid, are insisting increasingly that managed care plans be publicly accountable for the quality of care and service delivered. NCQA has responded to that demand with programs that assess both the organization and operation of the plan and the results that the plan actually achieves. Although our capacity to evaluate managed care is still incomplete, an increasingly complete picture of quality in managed care is emerging. We see evidence already that the capacity is driving improvement, and we hope that our work will mean that practicing physicians will find themselves better able to deliver the highest quality care possible to children in America.

Child↗