Quality Plus is NCQA’s multi-year program to transition to a new, more flexible generation of measurement and accreditation programs designed with the full range of health care entities in mind – particularly newer models such as consumer-directed plans. The program will also provide consumers and employers with invaluable new information to help guide choice.

Quality Plus was introduced as a voluntary program for plans with NCQA-Accredited commercial product lines. Plans may opt to achieve distinction in Quality Plus content areas in addition to their accreditation. Standards from two of the three voluntary areas will be a required part of accreditation.

Because accredited plans are on a three-year cycle, plans whose accreditation survey is in the future may continue to add Quality Plus as voluntary areas. Physician and Hospital Quality (PHQ) will remain voluntary for all plans.

Integrating Quality Plus into Accreditation

The creation of an entire new category of standards—Member Connections—reflects the growing emphasis on improving member access to health care information, facilitating early identification and outreach to members at risk for illness and providing the necessary tools. The first six standards match content area from the NCQA Quality Plus Program, but elements from CHI also round out this category.

The standards in this category apply only to commercial product lines and assess how well health plans facilitate their members’ ability to:

• Access health information, including health risk appraisals and interactive tools to improve their health
• Track claim and pharmacy information, including the ability to calculate their financial responsibility and order prescriptions by mail

CHI standards were integrated into the Quality Improvement (QI) category; specifically, elements from Helping Members With Chronic Conditions were added to Disease Management, and a new standard was added (Complex Case Management). These revisions reflect a greater emphasis on the following criteria.

• Whether organizations can identify members with or at risk for chronic and complex illnesses
• Whether organizations offer specific services to these members and work actively to manage and coordinate their care
• Whether organizations work consistently to improve the health of their most vulnerable members through case management and assessment of their effectiveness of care plan.

Because of the three-year accreditation cycle, many plans will not undergo a survey that includes the new standards until 2008 or after; therefore, NCQA will continue to offer plans the opportunity to undergo voluntary review under its Quality Plus Program and achieve distinction in these two areas. 

If you have any questions about NCQA's Quality Plus Program, please contact NCQA Customer Support at (888) 275-7585.