National Committee for Quality

Another external response to concerns about MCOs has been an increased interest in measuring the quality of care they deliver [35]. This interest has resulted in the development of numerous quality indicators. One example, HEDIS (Health Plan Employer Data and Information Set), is a standardized set of performance indicators used to compare health plans. Developed by the National Committee for Quality Assurance, HEDIS measures allow employers and employees to evaluate different plans. Only a small number of HEDIS indicators are related to medication use, but more drug-related indicators are likely to be added in the future. The use of quality indicators likely will increase as the measures become more refined and tested. 

National Committee for Quality Assurance (NCQA). 2007. Accreditation, certification and recognition available at http //web.ncqa.org/tabid/58/Defalt.aspx accessed on June 25, 2007. 

National Committee for Quality Assurance (NCQA). 2003. NCQA Overview. Washington, DC NCQA. 

Healthcare Organizations, National Committee for Quality Assurance. Coordinated performance measurement for the management of adult diabetes, April 2001, http //www.ama-assn.org/ama/pub/category/3798.html. Farmer KC. Methods for measuring and monitoring medication regimen adherence in clinical trials and clinical practice. Clin. Ther. 1999 21 1074-1090. 

Since the early 1980s, there has been a more than fivefold increase in the number of Americans enrolled in HMOs, which has had a dramatic impact on the delivery of healthcare in the United States. As a result of this trend, HMOs realized the need to demonstrate the quality of care they provided to their members compared with fee-for-service health plans however, at the time the industry lacked established standards. Subsequently, various independent review processes evolved, which often did not have consistent assumptions about the parameters that defined quality. It was not until the late 1980s that a group of HMO industry leaders recognized that an organization called the National Committee for Quality Assurance (NCQA) had the potential to act as an independent authority on quality control in managed care. ... 

The United States has several major performance measurement systems in place. Two of the most important systems are those directed by the National Committee for Quality Assurance (NCQA) for managed care organization (MCO) accreditation and The Joint Commission on Accreditation in Healthcare Organizations (JCAHO) for health care organization accreditation. Both NCQA s performance measurement system, HEDIS, and JCAHO s IMSystem include several pharmaceutical outcomes indicators. 

Health Plan Employer Data and Information Set (HEDIS) a core set of performance measures to assist employers and other health purchasers in understanding the value of health care purchases and evaluating health plan performance. HEDIS 2.0 is currently used and distributed by NCQA (National Committee for Quality Assurance). HEDIS 3.0 is under development. 

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