The National Committee for Quality Assurance: An Accountability System for Managed Care Organizations
- Publication:
- World Conference on Quality and Improvement
- Date:
- May 1995
- Issue:
- Volume 49 Issue
- Pages:
- pp. 301-309
- Author(s):
- Spoeri, Randall K., Ph.D.
- Organization(s):
- National Committee for Quality Assurance, Washington, DC 20005
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Abstract
This abstract is an edited version of the author's original.
This paper provides an introduction to the following organizations: the National Committee for Quality Assurance (NCQA), HEDIS (Health Plan Employer Data and Information Set), the National Report Card Pilot Project. The author also discusses health plan data quality auditing.
NCQA is an independent, nonprofit organization that assesses the quality of managed care organizations. The main goals of NCQA are: (1) foster the development and strengthening of internal systems at health plans for quality improvement; (2) assess the quality of medical management; and (3) develop more reliable and comparable measures of system performance in clinical quality and the quality of service.
HEDIS is an effort to standardize how health plans measure and report performance information. HEDIS 2.0 is a tool for purchasers to glean information and assess value; it is also a way for health plans to simplify measurement and reporting.
The Report Card Pilot Project (RCPP) was a one-year project, completed during 1994, with public reporting taking place in February, 1995. Twenty-one health plans sponsored the project. Their goal was to establish an ongoing mechanism to make reliable, comparative data on health plan performance available in the public domain.Auditing health plan data, such as HEDIS, assures the integrity of measures and defines problem areas and processes needing improvement.