155799 Impact of HEDIS measures and the NCQA on cancer screening by health insurers

Monday, November 5, 2007: 11:00 AM

Mona Sarfaty, MD , Health Policy, Thomas Jefferson University, Philadelphia, PA
Ronald Myers, PhD , Medical Oncology, Thomas Jefferson University, Philadelphia, PA
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.

Learning Objectives:
1. Explain the significance of the NCQA and the HEDIS measures it publishes. 2. Describe the actions taken by NCQA with regard to screening for colorectal cancer and the reasons they took those actions. 3. List three examples of the effect that NCQA and its HEDIS measures for colorectal cancer screening have had on insurers in the state of Pennsylvania.

Keywords: Quality, Insurance-Related Barriers

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.