1. Buying Quality HPA 420 Spring 2000

2. Plan for Today  Accreditation of MCOs National Committee for Quality Assurance (NCQA)  Performance Measures Health Plan Employer Data and Information Set (HEDIS)  Report Cards Consumer Assessment of Health Plans (CAHPS)  Examples of quality reports available on the web

3. Accreditation How do employers judge plans and feel assured that they are indeed buying value? Involves a review of information and on-site visit to examine a plan’s systems and structures Ensure that basic standards are met “Seal of approval” for purchasers

4. National Committee for Quality Assurance (NCQA) Private, Not-for-Profit Organization Began accrediting health plans in 1991 Response to the need for standardized, objective information about the quality of MCOs >50% of HMOs and POS plans have earned NCQA accreditation Will begin accrediting PPOs in July 2000

5. NCQA Accreditation (con’t) One of these overall accreditation statuses are awarded: Excellent Commendable Accredited Provisional Denied

6. Performance Measures Standardized measures to compare MCOs Measure the ability of the plan to deliver high quality care and consumer satisfaction For purchasers to feel assured they are buying value For consumers to use when choosing among plans

7. Health Plan Employer Data and Information Set (HEDIS) Began as an independent, voluntary effort by business and MCOs Employers’ perspective on HEDIS MCOs’ perspective on HEDIS Initially released by NCQA in 1993 Today > 300 plans report HEDIS data to purchasers

8. HEDIS (con’t) What does HEDIS measure? Examples of some measures: Advising Smokers to Quit Beta Blocker Treatment after Heart Attack Breast Cancer Screening Cesarean Section Rates Cervical Cancer Screening Childhood Immunizations Diabetic Eye Exams Prenatal Care in First Trimester

9. Beta Blocker Treatment After a Heart Attack What is measured? The percentage of members age 35+ who were hospitalized and discharged with the diagnosis of acute myocardial infarction who received a prescription for beta blockers. Why important? Heart disease leading cause of death in U.S. Total cost of medical care and lost productivity $60 billion/year Beta blockers are effective, low cost drugs shown to reduce morbidity and mortality associated with heart disease How is the managed care industry doing on this measure?

10. Beta Blockers After a Heart Attack

11. Report Cards Publish the results of performance measures For one plan For several plans Absolute ratings Comparative ratings

12. Websites NCQA http://www.ncqa.org Pacific Business Group http://www.healthscope.org New Jersey HMO Performance Report http://www.state.nj.us/health/hmo99 Foundation for Accountability http://www.facct.org