Who’s Watching My Health Plan? How Good Is My Doctor? Robert E. Rzewnicki, MD Chief Medical Officer March 3, 2009.

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Presentation transcript:

Who’s Watching My Health Plan? How Good Is My Doctor? Robert E. Rzewnicki, MD Chief Medical Officer March 3, 2009

1 Who’s Watching My Health Plan? The NCQA is. National Committee For Quality Assurance (ncqa.org)  Accrediting body for health plans  Not-for-profit founded in 1990 Goal: assess, report on and improve the quality of health care

2 National Committee for Quality Assurance Healthcare Effectiveness Data and Information Set (HEDIS)  (Most) Widely used performance measurement tools Domains of care (74 measures)  Effectiveness  Access Plan Stability Informed Choices  Satisfaction  Cost Use of Services Plan Information

3 Childhood Immunization

4 University of Michigan Health Management Research Center Prenatal Care

5 Physician Accessibility

6 Health Plan Service

7 How Good is My Doctor? How Can I Tell? NCQA–developed recognition programs  Diabetes  Heart disease and stroke  Back pain (physicians and chiropractors)  Information technology use  Medical Homes

8 Where Do We Go From Here? Summary  Doctor, hospital and health plan performance is measured more than ever before  Current measurement tools are imperfect but continue to be refined  Provider adherence to evidence-based guidelines and increasing information system use should be encouraged in all settings

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