Posts Tagged ‘NCQA’

Infographic: Top 11 Health Plans in 2015

October 12th, 2015 by Melanie Matthews

Capital District Physicians’ Health Plan (HMO) and Capital District Physicians’ Health Network (HMO), both of New York, were the top rated health plans by NCQA in 2015, according to a new infographic by HIMSS Media, which highlights the NCQA findings.

NCQA used combined HEDIS, CAHPS and NCQA Accreditation standards scores as of June 30, 2015 to develop the ranking. The HIMSS infographic shows the top 11 health plans, based on these scores.

Top 11 Health Plans in 2015

A multi-layer, patient-centered approach to care coordination of Memorial Hermann’s ACO covered lives is designed to cover these members under a population health umbrella spanning the entire continuum of care from wellness services to supportive services for end-of-life care.

During Care Coordination in an ACO: Managing the Population Health Continuum from Wellness to End-of-Life, a September 29th webinar, now available for replay, Mary Folladori, RN, MSN, FACM, CMAC, system director of care management at the Memorial Hermann Physician Network and ACO, provided the inside details on its care coordination strategy and results.

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Adapting 3 NCQA Standards for the Patient-Centered Medical Home

January 24th, 2014 by Cheryl Miller

Coming from a group of innovators who had adopted EHRs early on and were not afraid of data, participants in the Hudson Valley medical home transformation project decided to concentrate on three out of nine NCQA standards: access and communication, inpatient self-management, and performance reporting, explains Paul Kaye, MD, medical director at Taconic IPA.

Let’s move on to the nine standards of NCQA. All of them are available at NCQA’s Web site. We found that we needed to concentrate primarily on the areas of access and communication, inpatient self-management and performance reporting. It’s not to say that the other pieces don’t warrant a challenge, but many of them reflected EHR use and the ability to report on that use rather than a radical transformation of practice.

Initial steps were to require all of our practices to take TransforMED’s medical home IQ self-examination. Then a practice work plan for each practice was created. There was a staff-wide kickoff with each practice. Scheduling that was a challenge for busy private practices, as well as for the community health centers. Regular contact occurred between the coaches with timetables and deliverables that were there for particular elements and standards that had to be met.

Our medical council met once a month. The council included the physician and non-physician leadership of each practice. We highlighted a different standard at each meeting, shared best practices and came to an agreement on the three conditions that one needs to identify for NCQA medical home recognition. There was agreement across the practices that diabetes was an important condition in our area and there was also agreement on adopting practice guidelines, which had already been worked on at the statewide level, so that was a non-controversial area to be able to tackle. We also had two full-day workshops called learning collaboratives, and continue to have these every six months. For these workshops, outside speakers of national prominence came to talk about the medical home and some of the changes that needed to be done.

With all those areas of success, we had no difficulty agreeing on a clinically important condition and on defining a few more to pick from. Agreement on practice guidelines again came easily because of work that had already occurred. Most of the practices found that the standards that required documentation of an EHR functionality, while challenging to document on a piece of paper, were already present and didn’t require much radical change in their practice. These are the low hanging fruit, and showing some of this early on started to build the spirit of cooperation among the providers.

Excerpted from Guide to Physician Performance-Based Reimbursement: Payoffs from Incentives, Data Sharing and Clinical Integration.