Managed Care - February 2009 - (Page 49) PLAN WATCH Every Insurer Is Capable Of Delivering High Quality What are some of the common characteristics of health plans that have high scores from the National Committee for Quality Assurance? By Frank Diamond he annual ranking of health plans by the National Committee for Quality Assurance and U.S. News & World Report has garnered interest beyond the managed care industry. Integral to the rankings published in U.S. News are a health plan’s NCQA accreditation scores. Insurers that receive the highest rating, “excellent,” rev up their media machines and get the word out. These sorts of lists raise questions for companies that want to be on them: Are there characteristics that the best performers share? Has the percentage of “excellent” plans grown? The answers are “yes” and “yes.” NCQA has been accrediting health plans since 1991, and in the early years, there was no excellent rating, but rather something called full accreditation, says Kathleen C. Mudd, MBA, RN, vice president for product delivery. NCQA introduced “excellent” in the summer 1999, at the same time the organization began to use HEDIS measures of clinical quality in its accreditation scoring. As far as the number of plans that made the top tier, “We have seen a change over time,” says Mudd. “Only about 15 percent achieved full accreditation during the first survey. Now 85 percent get an excellent rating.” T dards and guidelines — are available.” Of course, a health plan can’t get the standards without paying for them, points out Jaan Sidorov, MD, a former medical director who is now a health care consultant and a member of MANAGED CARE’s Editorial Advisory Board. “Once you pay, however, the standards are clearly stated and you know exactly what you need to do to fulfill them.” Balancing act Mudd adds, “The organizations that do the best have an organizational commitment to quality that starts with the CEO. It’s just pervasive throughout the whole organization. The CEO sets the tone, and when he has a belief that improving health care quality is really the right thing to do, that’s how the organization is going to operate and that really makes a difference.” Sidorov agrees that CEO buy-in is a necessary first step. “You also need to put up with a lot of detailed documentation and process.” Which sometimes obscures the true goal of which accreditation is merely a byproduct, says Mudd. Improvement is what insurers should really want. “You’re able to become accredited because you’ve got the commitment, you’ve allocated the resources, you’ve got good information systems that allow you to collect and integrate and analyze data so that you know where you are and what your improvement opportunities might be,” says Mudd. An excellent score can be achieved without CEO buy-in, of course, but lack of support makes it much more difficult. Why would any executive not want NCQA accreditation? “It’s not that they wouldn’t want it,” says Jeff Van Ness, an NCQA spokesman. “It’s more an issue of balancing limited time and resources against competing priorities. Quality improve- “The organizations that do the best have an organizational commitment to quality that starts with the CEO,” says Kathleen Mudd, MBA, RN, vice president for quality delivery at the NCQA. High stakes Part of that is due to the enhancement of the NCQA brand, she says. “The stakes are much higher now, and getting excellent accreditation is critical,” says Mudd. “Organizations that don’t have accreditation now know that it’s critical that they wait until they are truly confident that they are going to be able to get that excellent rating before they start the process. We also have really come a long way in terms of the information that we make available. We’re entirely transparent. All our requirements — our stan- FEBRUARY 2009 / MANAGED CARE 49
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