National Committee for Quality Assurance unveils connectivity standards for health plans

The quality standards are in four areas covering insurers' use of technology to better serve their members.

By Tyler Chin, AMNews staff. Sept. 6, 2004.

The National Committee for Quality Assurance has drafted standards to measure the level of electronic connectivity between health plans and their members.

The proposed standards, which were released for public comment in August, will assess how insurers use technology tools to deliver information and services to their members in four areas, said Margaret E. O'Kane, president of NCQA, a Washington, D.C., nonprofit organization that accredits health plans. Those areas are:

• Support and information. This category will examine whether health plan members can electronically access services and information, including being able to change physicians, order enrollment cards, look up the cost of a given procedure or therapy, and provide feedback.
• Claims. NCQA will be looking at whether plans enable members to submit and track claims electronically and if claims are processed accurately and in a timely manner.
• Pharmacy benefits. NCQA will look at whether members can access information about their pharmacy benefits; medication costs; information about drug-to-drug interaction and generic substitutions; and order refills online.
• Self-management. This category examines if plans offer interactive tools and evidence-based information that members can use to help them stop smoking, lose weight or otherwise improve their health status.