Inside FDA Compliance

NCQA  |  07/06/2009

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Purchasers, Consumers Can Compare Health Plans' Resource Use

Reporting on relative resource use for diabetes and asthma allows plan comparison using standardized, risk-adjusted data.

(NCQA: Washington) -- Beginning in 2010, the National Committee for Quality Assurance (NCQA) will publicly report on health plans' resource use for patients with diabetes and asthma. The reporting of these two relative resource use (RRU) measures will allow purchasers and consumers to compare plans' relative efficiency in caring for such patients using standardized, risk-adjusted data.

"Purchasers have long been calling for ways to make apples-to-apples comparisons among health plans on the basis of not just quality, but also efficiency," says Margaret E. O'Kane, NCQA's president. "Given the rising costs of care, smart health-care shoppers are looking to be able to choose plans that deliver the right mix of quality and value. Publicly reporting RRU measures will allow them to compare plans against national benchmarks, and one another."

The proposal to move the RRU measures to public reporting was approved by NCQA's Committee on Performance Measurement, a group which comprises of a wide range of health care thought leaders, including physicians, purchasers, consumers, labor, and plan representatives.

Major employers lauded the move. "Comparing health plans on resource use will be invaluable in our efforts to make contracting decisions that help keep our colleagues and their families healthy while maintaining affordability," says Dennis White, senior vice president of Value Based Purchasing, National Business Coalition on Health. "If we're going to buy health care on the basis of value, we're going to need to know what's really driving costs. That's the role these RRU measures will play in our purchasing process."

NCQA introduced RRU measures as part of its Health Care Effectiveness Data and Information Set (HEDIS) 2007 data set. In total, RRU measures address six key areas of care: diabetes, asthma, low back pain, chronic obstructive pulmonary disorder (COPD), cardiovascular disease, and uncomplicated hypertension. Taken together, these six conditions account for up to 60 percent of all direct medical expenses. While health plans have reported on all six conditions for the past two years, only regional benchmarks have been publicly reported to date as NCQA has refined the data collection and analysis process.

The Committee on Performance Measurement will consider moving the remaining four RRU measures to public-reporting status at its next meeting in September.

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Since its founding in 1990, NCQA has been a central figure in driving improvement throughout the health care system, helping to elevate the issue of health care quality to the top of the national agenda.