New health plan accreditation rules would scrutinize narrow networks


The National Committee for Quality Assurance (NCQA) wants to overhaul its health plan accreditation program to better align with market and stakeholders needs, HealthcarePayerNews reported.

With that in mind, the proposed changes focus on provider networks and transparency.

The NCQA wants to introduce two new requirements related to narrow networks, tailored networks and high-value networks. Under the first requirement, health plans must annually monitor member experience and the quality of practitioners and hospitals in narrow networks. The other requirement would require transparency around policies that allow consumers to access out-of-network providers for covered services.

The new requirements stemmed from research showing member experience indicates the quality and adequacy of a health plan's network.

"The availability of this type of information may also help with employee communication and outreach, which in turn could aid proliferation of value-based insurance designs," the NCQA states.

The NCQA's proposal would also update HEDIS (Healthcare Effectiveness Data and Information Set) and CAHPS (Consumer Assessment of Healthcare Providers and Systems) scoring. The NCQA wants to annually score all health plans using the same measures and methodology to ensure greater consistency and comparability across plans.

The organization also plans as retire some of the scoring measures as well as implement a new all-plan cause readmission measure. While the changes would not retroactively affect currently accredited health plans, the NCQA expects an annual rescoring process for all health plans in 2018.

Moreover, already accredited health plans should know that the new scoring policy could affect their accreditation status and as well as their wallets if they included performance guarantees in contracts with purchasers.

The public can comment on the proposed changes until April. The NQCA expects the changes to take effect July 1, 2015.

To learn more:
- Healthcare Payer News article
- read the NCQA proposed changes (.pdf)

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