Managed Care - February 2009 - (Page 50) PLAN WATCH ment requires a great deal of care and feeding.” Sidorov cautions that NCQA accreditation impresses many health plan customers, but not all. “The marketplace appears to look for it at the large employer level,” says Sidorov. “However, small businesses and individuals don’t really care about accreditation. They care about price.” Getting an excellent grade and saving money may not be compatible goals, he cautions. “Maybe I’m being naïve, but I have to wonder if HEDIS accreditation drives up costs because plans charge a premium for quality.” Quality costs, and plans that do well with NCQA clearly have made an investment in information technology, says Mudd. “Such insurers are able to produce the data and analyze performance, and that really helps them know how they are performing.” NCQA’s excellent health plans also demonstrate an ability to collaborate with physicians and other providers, says Mudd. “They work together toward a common goal.” To do this they must overcome the tension that often exists between plans and doctors. “They realize that engaging physicians and talking about strategies that work is a better approach than forcing things down a physician’s throat,” says Mudd. The physician evaluators are not NCQA employees but contracted experts. “These physicians have worked in managed care organizations,” says Mudd. “They have backgrounds in quality improvement and medical management. They are often working full time in health plans, and they get time off from their organizations to do these surveys. They go through a rigorous training program before they start surveying for us. They have to do a minimum number of surveys each year. We do surveyor updating training every year so that they can stay current with us.” Detailed information About 50 percent of the evaluators are physicians; the other half are nurses or administrative surveyors. “There’s very detailed information available on how we are going to survey them, what we are looking for, how they are going to be scored,” says Mudd. “Because the surveyors we use come from the health care industry, there’s great knowledge out there now. Health plans have resources and have knowledge and familiarity with our requirement.” In other words, to use the metaphor bandied about in discussions about education, the NCQA in a sense teaches to the test. “Our standards lay out the road map that says if you really want to be a strong performer and you want to effectively manage and improve care, here’s what you need to do. They lay out the kind of infrastructure you need, the things that you really need to do. NCQA provides feedback.” That gives Sidorov some pause, however. “NCQA accreditation is becoming a baseline floor in the marketplace because so many plans have it,” he says. “It used to be a ceiling to aspire to. That’s good if it raised all boats. It’s not so good if everyone has entered the world of Lake Wobegon.” NCQA has consistently raised expectations, says Mudd. “Even though we raise the bar, the performance remains at a high level because it’s so important to purchasers. Health plans devote staff and information resources to the effort, and take a lot of time to prepare. It generally takes between 12 and 18 months.” MC Team of doctors On another level, physicians are involved directly in the accreditation process. A team of doctors analyzes the data collected by the NCQA’s on-site evaluators. “We have a significant number of requirements in our accreditation program,” says Mudd, “and we use physician surveyors to review performance against the requirements that really are clinically focused.” Next Month in MANAGED CARE The concept of the company doctor goes back 150 years, but has been out of favor for decades. Now, onsite clinics are springing up, and this might not be in the interest of HMOs and other managed care companies. 50 MANAGED CARE / FEBRUARY 2009
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