Dive Brief:
- The National Committee for Quality Assurance (NCQA) on July 28 released Health Plan Accreditation (HPA) 2015, becoming the first in the industry to address the trend of "narrow network" or "tailored network" health plans: an increasingly popular cost-containment strategy.
- Private, nonprofit NCQA, the health insurance industry's leading accreditation program, said enhancements in HPA 2015 include network transparency requirements, and prioritizing quality measures emphasizing value and outcomes.
- New standards for network transparency apply only to marketplace plans sold on exchanges.
- Specifically, HPA 2015 requires marketplace plans to disclose their criteria for including hospitals and physicians in their networks, "in easy-to-understand language online." Also, HPA 2015 requires plans to monitor complaints, appeals and requests for out-of-network services, which NCQA said will help plans "discern when network size may undermine quality."
Dive Insight:
"Health Plan Accreditation 2015 gives health plans that want to use smaller provider networks a guide for doing so in ways that promotes transparency and protects consumers," said Patricia Barrett, NCQA's vice president for product development. NCQA said its network transparency requirements will give plans limiting the number of contracted physicians and hospitals in their networks "a way to stand out for tailoring their networks based on quality, rather than cost alone." Disclosures also will help consumers select exchange plans that have made quality a priority in building their networks, NCQA said, asserting that narrow-network plans already comprise some of the highest performing commercial insurers and show that high quality and small networks can be compatible.
NCQA's latest standards on plan network adequacy seem encouraging for the provider community. To deliver promised benefits, plans must provide reasonable access to a sufficient number of hospitals and physicians. Using new standards that promote transparency in this process for plan accreditation is all to the good—especially as a way to help decrease consumers' confusion over plan selection, and to ensure that plans will monitor consumers' concerns in a timely manner.