Question

1.  NCQA-NATIONAL COMMITTEE FOR QUALITY ASSURANCE. In two single spaced typed paragraphs describe what is NCQA--its history and key objectives. Use essay form and as with previous assignments, reference the article.

2.  In one single spaced paragraph answer: What is HEDIS?  Give two examples of HEDIS measures.  NOTE:  YOU MAY NOT USE WIKIPEDIA AS YOUR SOURCE.  YOU MUST GO TO THE WEB SITES OF NCQA AND HEDIS AS YOUR SOURCES.

Answer 1

1.  NCQA-NATIONAL COMMITTEE FOR QUALITY ASSURANCE.

Immediately after the presentation of the problem-based approach to quality assessment in the early 1970s, the Comprehensive Quality Assurance System was tested. The National Committee for Quality Assurance (NCQA) was formed as per the request of the federal Office for Health Maintenance Organizations (HMOs) in 1979 and it was sponsored by the Group Health Association of America and the American Association of Foundations for Medical Care. The committee invited Sapin and Rubin- the founders of problem-based approach to quality assessment - to join. Rubin’s problem-focused review method was adopted by the committee. Identifying and correcting problems was emphasized by NCQA instead of the traditional audits. Sapin and Rubin utilized the KP scheme which had two levels. The first level is identifying the possible trouble spots by a variety of methods and assessing the identified problems according to 56 monitoring criteria. In the second level, the problems are fixed through process changes.

In 1980s NCQA was withdrawn its financial support as the HMOs needed an independent quality assurance body to review their operations. by an independent quality assurance body. NCQA was reconfigured and launched a renewed mission in 1990 and managed to get funding to reconfigure as an independent agency. Before the development of NCQA, the health care system was operating data-free. NCQA utilized the measurement, transparency and accountability to highlight top performers and drive improvement. In 1990 NCQA started to measure and accrediting health plans. In 2008 NCQA has elaborated its assessment to the quality of medical providers and practices. Government and private sector clients utilize the help of NCQA to help them measure and improve quality and support NCQA through contracts and grants.

The ultimate mission and vision of NCQA are to “improve the quality of health care” and “Better health care, Better choices, Better health” respectively. NCQA utilizes the help of external committees and advisory groups including consumers, employers, HEDIS Users Group (HUG), Accreditation/Certification Users Group members, Federal and state government officials, leaders for the achievement of its goals. NCQA develop strategies to measure, analyze, improve, repeat to improve standards. NCQA also runs training programmes for healthcare workers to improve the standard of care. In conclusion, NCQA is a non-profit organization which is dedicated to providing information to the consumers of managed health care that enables them to distinguish among plans based on quality. The accreditation programme of NCQA has begun in 1991 with MCOs. Then it has been expanded to behavioural health care organizations, credentials verification organizations, physician organizations, and PPOs, most recently. Health Plan Employer Data and Information Set (HEDIS) was developed to create a performance measurement set in 1992 in collaboration with MCOs, academic researchers, corporate purchasers, and consumer representatives.

References:

1. https://kaiserpermanentehistory.org/latest/birth-of-the-national-committee-for-quality-assurance/

2. https://www.ncqa.org

3. https://www.niddk.nih.gov/health-information/communication-programs/ndep/health-professionals/practice-transformation-physicians-health-care-teams/team-based-care/patient-centered-medical-home/national-committee-quality-assurance-overview

4.https://www.ahrq.gov/professionals/quality-patient-safety/talkingquality/resources/initiatives/ncqa.html

5.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4194707/

2. Healthcare Effectiveness Data and Information Set (HEDIS)

The Healthcare Effectiveness Data and Information Set (HEDIS) is developed and managed by the National Committee for Quality Assurance (NCQA) and is a widely used set of performance measures in the managed care field. The HEDIS measures focus largely on processes of

care. It actually measures the receive and coded care for the patient, not just the ordered care. These measures can be the basis for quality improvement activities.

Examples of HEDIS measures are Childhood – Immunizations, Well Child Visits, Adult Preventive care like Breast & Cervical Cancer Screening.

References:

1.https://www.cms.gov/Medicare/Health-Plans/SpecialNeedsPlans/SNP-HEDIS.html

2. https://www.ncqa.org/hedis-2018-measures/