Impact of HEDIS measures and the NCQA on cancer screening by health insurers

In 2003, the National Committee for Quality Assurance (NCQA) added colorectal cancer (CRC) screening to the measures required in the Health Plan Employer Data Information Set (HEDIS), and announced their intention to report these to the public in 2006. As a part of a study of cost, coverage and capacity for CRC screening in the state of Pennsylvania and to determine whether the NCQA initiative had impact, we conducted a survey of commercial insurers regarding their health plans. The survey was conducted in the summer of 2006. All 13 insurance companies that met the enrollment criteria responded: 6 on behalf of preferred provider organizations (PPO's), 2 about health maintenance organizations (HMO's), 3 about point of service plans (POS), and 2 about fee for service plans (FFS). The total enrollment in the responding plans was 8.3 million. Results of the survey indicated that 9 of 13 plans now measure their CRC screening rate; 7 began during or after 2003, and 1 before 2003. Eight report their rates to NCQA. In response to the HEDIS measures, 7 plans revised their screening guidelines, 6 established new or updated reminder systems for enrollees or providers, 6 established new systems for tracking screening rates, and 5 established new guidelines or protocols. The NCQA guidelines have had impact on health plan policies and practices with respect to colorectal cancer screening in the state of Pennsylvania.