NCQA Receives Grants To Explore Offering Provider-Level Reports, Streamline Physician Oversight

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The National Committee for Quality Assurance (NCQA) announced today that it has secured grant funding from the Commonwealth Fund and the California HealthCare Foundation (CHCF) to explore consumer information needs on physician quality, and to streamline physician group oversight in California. The Commonwealth Fund's grant supports a 21-month study to develop measures of physician quality based on input from consumers, purchasers and health care organizations. CHCF has funded the Physician Group Oversight (PGO) Improvement Project, a partnership of NCQA, CHCF and the Pacific Business Group on Health (PBGH), to improve the efficiency of physician group oversight in California. "Consumers want information about their doctors," said NCQA President Margaret E. O'Kane. "We're going to fill that need. That's the level of the system that they deal with, so information about provider quality is information they can use." Provider-Level Information Under the Commonwealth Fund grant, NCQA will explore the development of consumer-friendly measures of physician and physician group quality. Currently, there are few such measures, if any, and little is understood about the types of information consumers need and want. Historically, many consumers have tended simply to assume that their physicians delivered high quality care or, alternately, have formed opinions about their providers based on the opinions of friends or family. NCQA will convene an expert panel, and use surveys and focus groups of consumers to determine what information consumers want, when they need it and how they prefer it to be presented. NCQA will also work with physician organizations, other accrediting organizations, health plans and others to understand better how to meet consumer needs for information and to explore how to make existing information on physician quality more widely available to consumers. In addition, NCQA will explore how existing performance measures could be modified or aggregated to provide consumers and physicians with relevant information about health care quality at the group or individual practice level. "Informed consumers are essential to improving the quality of health care, but the challenge is to provide information that individuals can and will use in making choices about their care," said Karen Davis, president of The Commonwealth Fund. "This project is ground-breaking because for the first time, we are asking patients what's important for them to know about their doctors-and how they will use that information." Streamlining Physician Group Oversight As part of NCQA's efforts to address quality measurement at a different level of the system, CHCF is funding the PGO Improvement Project, which seeks to streamline the California system of multiple oversight requirements for managed care organizations (MCOs) and their contracted physician groups. Many California MCOs use a delegated model, in which plans delegate responsibility for various functions (e.g., credentialing, utilization management) to large physician groups. Under this model, quality reviews from both public and private organizations (such as NCQA) start at the health plan level, but extend down to the physician group level. As a result, physician groups with multiple health plan contracts may contend with reviews from several oversight organizations and each of their health plan partners. In light of this often redundant oversight process, the 12-month goal of the PGO Improvement Project is to reduce the physician groups' cost of oversight through streamlining existing reporting and oversight activities. The project team, which includes representatives from managed care and provider organizations, the California Department of Managed Health Care, the California Department of Health Services and the Health Care Financing Administration (HCFA)'s Region 9, will determine areas of overlap in major oversight processes related to functions such as credentialing, grievance appeals, and measuring access. Once these areas have been identified, the project team will design suggested changes for those processes. In particular, the group will look for ways to streamline data collection. The goal is to reduce redundant oversight and create the opportunity to institute efficient evaluation processes that will provide consistent information on the quality of care provided by individual physician groups. "The Physician Group Oversight Improvement Project is important to purchasers, regulators and consumers because it will help ensure that physician groups are accountable while reducing duplication in oversight," stated Peter Lee, PBGH President and CEO. "Our goal is to channel available resources into better measures of quality and to make that information widely available to health care consumers." "This is an exciting opportunity to bring together all of the key players who define and set oversight standards to look collectively at how we can reduce the burden on health plans and the medical groups with which they contract," said Ann Monroe, director of CHCF's Quality Initiative. "Because the Foundation's interest is improving quality of care, we're hoping some of the energy and resources freed up from streamlining the oversight process can be refocused on improving quality of care for consumers and patients." NCQA is a private, non-profit organization dedicated to improving health care quality by recognizing and rewarding organizations that deliver high quality care and service. NCQA's efforts to provide organizations with an incentive to focus on quality have helped save many thousands of lives over the past 10 years. NCQA is committed to evaluating and reporting on health care quality to help consumers, employers and others make more informed health care choices. The Commonwealth Fund is a private foundation supporting independent research on health and social issues. To order publications, visit its Web site at www.commonwealthfund.org or call (888) 777-2744. The California HealthCare Foundation, based in Oakland, is a nonprofit philanthropy whose mission is to expand access to affordable, quality health care for underserved individuals and communities and to promote fundamental improvements in the health status of the people of California. The Foundation, established in 1996 as a result of the conversion of Blue Cross of California to a for-profit entity, is independently managed. The Web site can be found at www.chcf.org.

Publication Details

Publication Date:
February 22, 2001

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