Value-Based Care News

NCQA Calls for Public Comment on Health Plan Accreditation

By Ryan Mcaskill

The NCQA has proposed changes to the HPA that will focus on measures that incentivize plans to focus on value-based strategies.

- The National Committee for Quality Assurance (NCQA) recently announced proposed changes  to the organization’s Health Plan Accreditation (HPA).

The NCQA describes the HPA as the most widely recognized accreditation program in the United States and that “researches the quality and improves the managed care experience for health plans, patients, physicians and employers.” It adds:

The most comprehensive evaluation in the industry, and the only assessment that bases results of clinical performance (i.e., Healthcare Effectiveness Data and Information Set (HEDIS) measures) and consumer experience (i.e., Consumer Assessment of Health Plans Study (CAHPS) measures). High-performing health plans choose NCQA Accreditation because it satisfies many stakeholders: employer, regulatory and consumer demands.

The stakeholders use the accreditation in different ways.

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  • Employer – Many employers will only do business with NCQA-Accredited plans. Purchasers want to maximize the value of their healthcare spending and the National Business Group on Health use this accreditation as an important indicator of the plan.

    Regulatory – The accreditation contains all key elements that federal law and regulations require for the State Health Insurance Marketplace plans. Forty states recognize NCQA Accreditation as meeting requirements for Medicaid plans and more than a dozen mandate it for Medicaid. Medicare deems plans with the accreditation for Medicare Advantages.

    Consumer – Comparison-shopping is a major factor of the consumer side of healthcare. Having the accreditation helps any plan stand out and be more attractive for consumers.

    The Department of Health and Human Services has selected NCQA as an accrediting entity for Qualified Health Plan issuers participating in the Health Insurance Exchange Marketplace. There are three evaluation options (interim, first, renewal) that created a “glide path” or a flexible opportunities for researching accreditation, regardless of a plan’s longevity or experience with quality reporting.

    The changes proposed by the NCQA would require additional HEDIS and CAHPS measures for the 2016 reporting year to better evaluate and differentiate health plan performance. It will incentivize plans to focus on value-based strategies. As with many proposed changes of this nature, the NCQA has called for a period of public comment. This allows insurers, consumers, employers and other stakeholders to address concerns in the program and help shape it for the better.

    “Public comment is a chance for groups to help NCQA shape the next generation of our accreditation program,” Patricia Barrett, NCQA’s Vice President of Product Development, said in the release. “Input from diverse stakeholders ensures the soundness and usability of NCQA programs.”

    The public comment has been extended until Monday, December 15, 2015. The final list of measures for submission and scoring in June 2016 will be released on the NCQA’s Website in April of 2015. The public comment is specifically intended for input on adding HEDIS and CAHPS measures to Health Plan Accreditation. A second public comment for updates to Health Plan Accreditation stands will take place in March 2015.