# Presentation: 483110

## September 22, 2006

**September 22, 2006**

**Web-based Tools for****Quality Evaluation****Margaret O’Kane****President, NCQA**

## Private, non-profit health care quality oversight organization
Independent since 1990
Measures and reports on health care quality
Committed to measurement, transparency and accountability
Unites diverse groups around common goal: improving health care quality

- Independent since 1990
**Measures and reports on health care quality**
**Committed to measurement, transparency and accountability**
**Unites diverse groups around common goal: improving health care quality**

**Notes:**

Points to mention: 

NCQA has a wide range of programs relevant to different parts and levels of the system.

Core part of our mission is providing information.  Much of the information we have is available free of charge on our Web site. We give more of it away free to the media so the HMO report cards you see are usually based on our data. 

As previously indicated, we build consensus.  We believe that it is critical for our programs to reflect the input, needs, desires of all the affected parties.  That means consumers, employers, providers, policy makers, health plans, etc.   Achieving consensus among these groups is a hallmark of our work and the reason for our success.  

## Quality Improvement: Key Principles 

**Measurement**
- We can’t improve what we don’t measure
**Transparency**
- Quality data must be translated into understandable, actionable reports for consumers and purchasers
**Accountability**
- Once we can measure we can hold everyone accountable for improvement

## The NCQA Process Includes:

**Standards for structural and procedural activities meant to ensure consumer protection on the payment and coverage front, quality customer service, and appropriate access to care.**
**Measures (HEDIS****®****) of the care which plan members receive in important, evidence based aspects of care.**
**A consumer survey (CAHPS****®****) of member experience with both the plan’s direct administrative performance and members’ experience with the delivery system**

## 10 Years of Public Reporting,10 Years of Progress

**HEDIS clinical qualty measures: Publicly reported since 1996**** **
**Past 7 years have seen continuous overall improvement in preventive care, treatment**** **
**Provider-level measurement efforts have expanded dramatically in recent years**** **
**Accountability has expanded accordingly**
**But work remains to be done**

## Selected Improvements: 1999 – 2004

**Selected Improvements: 1999 – 2004**

## Current Web-based Tools and Requirements

**NCQA Tools:**
- Interactive Survey System (ISS)
- Interactive Data Submission System (IDSS)
- Healthcare Organization Questionnaire (HOQ)
- Quality Compass 2006
**NCQA Requirements for Health Plans:**
- Member Connections Standards (MEM)

## Interactive Survey System

- Web-based, interactive tool for collecting information, documents needed for NCQA Accreditation, Certification programs
- Two components:
- - Standards and Guidelines
- - Survey Tool
- Mandatory for accreditation

## Goals for Creating the ISS

- Increase efficiency and quality of evaluation
- Enable cost-effective, timely process
- Provide organizations with a  readiness evaluation tool
- Expand information capabilities
- Maintain the rigor of accreditation while streamlining preparation time

## Standards and Elements

- Organization attaches documents

- Organization completes a readiness evaluation

## ISS Results

## Interactive Data Submission System

- Web-based system used to collect clinical HEDIS results; launching April 2007
- Users of IDSS:
- Health care organizations to submit HEDIS 	results
- NCQA-certified HEDIS compliance auditors
- NCQA-certified HEDIS software vendors
- NCQA data collection staff

## Slide 13

## Healthcare Organization Questionnaire 

- Web-based information supplied in the HOQ is used to:
- update the NCQA database with 	organization information and clinical and 	non-clinical submission requests
- track HEDIS and Accreditation status
- pre-populate key fields in the IDSS
- create IDs for HEDIS data submissions

## Member Connections Standards

- Released in 2005 as Voluntary and pass/fail
- 39 plans signed up as Early Adopters
- Plans achieved ‘Distinction’ upon passing; results publicly reported
- 55 plans have achieved Distinction, to date
- 42 surveys are scheduled for 2006; 2 are scheduled for 2007
- Standards fully incorporated into MCO and PPO products for 2007

## Member Connections Standards

- Member Connections standards *require* Web-based tools to ensure health plan members:
- understand the cost of services and know how to use their benefits
- have access to Health Risk Appraisals
- have access to self-management tools addressing major health risk factors
- can check on the status of their claims

## Health Plan Report Card: Member Connections

**Health Plan Report Card: ****Member Connections**

## Comprehensive database of health care performance information

Commercial plan HEDIS and CAHPS results
Plan-level data for: 
	253 plan submissions  45.7 million lives 
Average/benchmark data for:
	282 plan submissions  47.3 million lives

- Commercial plan HEDIS and CAHPS results
- Plan-level data for:
- 	253 plan submissions  45.7 million lives
- Average/benchmark data for:
- 	282 plan submissions  47.3 million lives

**Quality Compass 2006**

**Notes:**

Points to mention: 

NCQA has a wide range of programs relevant to different parts and levels of the system.

Core part of our mission is providing information.  Much of the information we have is available free of charge on our Web site. We give more of it away free to the media so the HMO report cards you see are usually based on our data. 

As previously indicated, we build consensus.  We believe that it is critical for our programs to reflect the input, needs, desires of all the affected parties.  That means consumers, employers, providers, policy makers, health plans, etc.   Achieving consensus among these groups is a hallmark of our work and the reason for our success.  

## Web-based, interactive database with custom features:

report builder allows user to select plans, measures, and benchmarks
trended data displays up to 3 years of performance results
data exporter downloads custom report data directly into Excel for further analysis

- report builder allows user to select plans, measures, and benchmarks
- trended data displays up to 3 years of performance results
- data exporter downloads custom report data directly into Excel for further analysis

**Quality Compass 2006**

**Notes:**

Points to mention: 

NCQA has a wide range of programs relevant to different parts and levels of the system.

Core part of our mission is providing information.  Much of the information we have is available free of charge on our Web site. We give more of it away free to the media so the HMO report cards you see are usually based on our data. 

As previously indicated, we build consensus.  We believe that it is critical for our programs to reflect the input, needs, desires of all the affected parties.  That means consumers, employers, providers, policy makers, health plans, etc.   Achieving consensus among these groups is a hallmark of our work and the reason for our success.  

## Quality Compass 2006

**Quality Compass 2006**

**Notes:**

Points to mention: 

NCQA has a wide range of programs relevant to different parts and levels of the system.

Core part of our mission is providing information.  Much of the information we have is available free of charge on our Web site. We give more of it away free to the media so the HMO report cards you see are usually based on our data. 

As previously indicated, we build consensus.  We believe that it is critical for our programs to reflect the input, needs, desires of all the affected parties.  That means consumers, employers, providers, policy makers, health plans, etc.   Achieving consensus among these groups is a hallmark of our work and the reason for our success.  

## Quality Compass 2006

**Quality Compass 2006**

**Notes:**

Points to mention: 

NCQA has a wide range of programs relevant to different parts and levels of the system.

Core part of our mission is providing information.  Much of the information we have is available free of charge on our Web site. We give more of it away free to the media so the HMO report cards you see are usually based on our data. 

As previously indicated, we build consensus.  We believe that it is critical for our programs to reflect the input, needs, desires of all the affected parties.  That means consumers, employers, providers, policy makers, health plans, etc.   Achieving consensus among these groups is a hallmark of our work and the reason for our success.