HPA 2020: Align Health Plan Accreditation and Ratings

As you’ve heard the Health Plan Accreditation (HPA) 2020 Standards and Guidelines are available.

And yes, we made changes.

Align Health Plan Accreditation and Health Plan Ratings

NCQA communicates plans’ ratings on clinical quality, member experience and Accreditation survey results through the Health Plan Report Card (HPRC) and Health Plan Ratings. Both reports use similar-yet-different methodologies. Differences in report can lead to inconsistencies in results.

Now, the evaluation of HEDIS®/CAHPS® performance is separate from standards scoring. Along with Accreditation status, Health Plan Ratings will indicate HEDIS/CAHPS performance on the NCQA Report Card.

Distinguishing Quality Plans

In the past, a health plan’s quality was determined by Accreditation status and numerical health plan ratings.

Not anymore. Say goodbye to the Excellent and Commendable status levels. Beginning with HPA 2020, Health Plan Ratings will distinguish quality.

Ratings will no longer be numerical (1-5) but a 5-star rating system. Half-star increments are included.

Take a look at what rating your current status may look like under the new rating system:

  • Excellent: 4.5-5 Stars
  • Commendable: 3.5-4 Stars
  • Accredited: 2.5-3 Stars
  • Provisional: 1-2 Stars

These are examples and your rating will be based on current performance using the ratings methodology.

HEDIS/CAHPS Portion of Accreditation

This new system includes a distinct set of measures for each product line. Each measure is classified in one of three categories:

  • Process measures: 1 Star
  • Outcome measures: 3 Stars
  • Patient experience measures: 1.5 Stars

HEDIS/CAHPS Plus Accreditation

The overall rating is the average of an organization’s HEDIS and CAHPS measure ratings, plus Accreditation bonus points (if the organization has NCQA Accreditation), rounded to the nearest half point.

Overall performance is measured in three subcategories:

  1. Consumer Satisfaction. Patient-reported experience of care, including experience with doctors, services and customer service (measures in the Consumer Satisfaction category).
  2. Rates for Clinical Measures. The proportion of eligible members who received preventive services (prevention measures) and the proportion of eligible members who received recommended care for certain conditions (treatment measures).
  3. NCQA Accreditation Standards Score. For an organization with an Accredited or Provisional status, 0.5 stars are added to the overall rating. An organization with an Interim status receives one-third of the 0.5 stars.

That is a load of information. But the biggest takeaway is the 5-star rating system will help improve transparency. When consumers see stars, they can easily make a choice.

Learn more

Stay tuned for future blogs on other focus areas we’ve updated.

Still need more on HPA?

We have an introduction webinar on the new 2020 standards with NCQA’s Assistant Vice President for Product Strategy and Development, Raena Akin-Deko. Take a listen.

Lastly, feel free to purchase the (HPA) 2020 Standards and Guidelines here.