ncqa publications_2010-2011.pdf

Order online: www.ncqa.org/publications or call 888-275-7585

2010–2011 Publications and ProductsYour Comprehensive Resource

2 www.ncqa.o rg/pub l ica t ions

Quality Compass: RRU + Quality Index (Commercial)Answeringthequestion,“Isthishealthplangivingmethebestreturnformyhealthcaredollars?”,ismorethansimplyaquestionofcost.Amorecompleteconsiderationisvalue—howaplan’scostandqualitycorrelate.Quality Compass: RRU + Quality Index (Commercial)isareportingtoolthatgaugestheresourcesaplanusestotreathigh-costchronicconditions,alongwiththeplan’sHEDISqualityresultsfortreatingthosediseases.RRU + Quality Indexallowsthecomparisonofhealthplansbasedoncostandvaluebecauseitexpressesaplan’sresourceutilizationandqualityresults,comparedwiththeaverageofplansthatserveasimilarpopulation.Byconsolidatingdiversecriteriaintoquantifiedpointsofcomparison,RRUmakesiteasiertochooseahealthplan.

Multicultural Health Care (MHC)Caringforanincreasinglydiversesocietyrequiresculturalskills,aswellasclinicalcompetence.MulticulturalHealthCare(MHC)isanevaluationprogramthatusesevidence-basedstandardstoratehowhealthcareplansandotherorganizationsmeasure,analyzeandadjusttheirservicestomeettheneedsofdiversepopulations.HealthcareorganizationsearnMHCDistinctionbymeetingrigorousstandardsinRace/EthnicityandLanguageDataCollection,AccessandAvailabilityofLanguageServices,PractitionerNetworkCulturalResponsiveness,CulturallyandLinguisticallyAppropriateServicesProgramsandReducingHealthCareDisparities.

Health Plan Accreditation to include Medicaid standardNCQAHealthPlanAccreditationrequirementsassessthequalityofcareprovidedbycommercial,MedicareandMedicaidhealthplans.From2009to2010,NCQAevaluatedcurrentaccreditationrequirementswithafocusonMedicaidhealthplans.TheevaluationaffirmedthatmanystateMedicaidofficesvalueNCQAAccreditationasarevieweragainstfederalrequirementsandbelievethatNCQAcanplayalargerroleinmeetingfederalrequirements.Consequently,

NCQAdevelopedavoluntaryMedicaidstandard,attachedtoitsHealthPlanAccreditationProgram,toincreasetheaccreditationstandardsequivalencywithfederalrequirements.Thesenewrequirementsinclude:

■ DirectAccesstoWomen’sHealthServices■ SecondOpinions■ Out-ofNetworkServices■ OutofNetworkCosttoMember■ HoursofOperationParity

WiththeunderstandingthatMedicaidhealthplansserveadiversepopulation,NCQAwillallowMedicaidhealthplanstouseChildrenorChildrenWithChronicConditionsCAHPSsurveyresults.

NCQA Fifth Annual National Policy ConferenceRegisterearlyforNCQA’sfifthannualNationalPolicyConferenceinWashingtonD.C.,onFriday,December3,2010.Discussionwillfocusonhowhealthplanscandelivervalueandthriveinthenew,post-reformenvironment,andhowtoimprovepopulationhealthandindividualpatientexperiencewhilereducingpercapitaspending.Leadersfromacrossthehealthcareindustrywillofferstrategiesfor:

■ Reportingoncostandquality,includinghowplanscanfeedqualitydatabacktoproviders

■ Designingbenefitstructurestosupportvalueandeffectivecare

■ Coordinatingcarethroughincentivesandinfrastructurechangestosupporthighperformance

■ Engagingpatientsinself-careandemployersinworkers’wellness

■ Formingrelationshipswithincommunitiestoshareresourcesandrewardprimarycare.

Seatsarelimited,sodon’twaittoregisterforthistimelysymposium!Programupdatesandregistrationareavailableatwww.ncqa.org/education.

WHAT’SNEW

8 8 8 - 2 7 5 - 7 5 8 5 3Policyupdates,changesandclarificationsarepostedatwww.ncqa.org/updates.

Performance Measurement 4

Healthcare Effectiveness Data and Information Set (HEDIS®) 4

Accreditation 6

Disease Management (DM) 6

Health Plans (HP) 7

Managed Behavioral Healthcare Organizations (MBHO) 7

Medicare Advantage (MA) 8

New Health Plans (NHP) 8

Wellness and Health Promotion (WHP) 9

Certification 10

Credentials Verification Organizations (CVO) 10

Health Information Products (HIP) 10

Physician and Hospital Quality (PHQ) 11

Utilization Management (UM)/Credentialing (CR) 11

Distinction 12

NEW! Multicultural Health Care (MHC) 12

Recognition 13

Back Pain Recognition Program (BPRP) 13

Diabetes Recognition Program (DRP) 13

Heart/Stroke Recognition Program (HSRP) 13

Physician Practice Connections (PPC) 13

Physician Practice Connections® (PPC)—Patient-Centered Medical Home™ (PPC-PCMH) 14

Data and Reports 14

Quality Compass® 14

NEW! RRU + Quality Index (Commercial) 15

Data Licensing Opportunities 15

Quality Dividend Calculator™ – Compass Edition 16

Additional Publications 16

How to Order 17

Discounts and Policies 18

NCQA Order Form 19

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA). Quality Compass® is a registered trademark of NCQA. PPC® is a registered trademark of NCQA. HEDIS Compliance Audit™ is a trademark of NCQA. PPC-PCMH™ is a trademark of NCQA. Quality Dividend Calculator™ is a trademark of NCQA. CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).

TABLEOFCONTENTS


HEDISHealthcare Effectiveness Data and Information Set (HEDIS) 2011HEDISistheindustrystandardinhealthcareperformancemeasurement,usedbymorethan90percentofthenation’shealthplansandmanyleadingemployersandregulators.HEDISisasetofstandardizedmeasuresthatspecifieshoworganizationscollect,auditandreportperformanceinformationacrossthemostpressingclinicalareas,aswellasimportantdimensionsofcustomersatisfactionandpatientexperience.

Please note that implementation (i.e., data collection and reporting) of HEDIS 2011 for the 2010 Reporting Year (using 2009 data) will require purchase of Volumes 2, 3 and 5.

Technical Specifications for Physician MeasurementHEDISisthemostwidelyusedsetofinpatientandambulatoryperformancemeasuresinthehealthcareindustry.ThispublicationisthenewestadditiontoNCQA’ssuiteofHEDISproducts.Itsupportsstandardizedmeasurementbyprovidingthetechnicalspecificationsnecessarytoenablereliable,equitableandvalidmeasurementandreportingofphysician-specificperformance,andappliestoindividualphysicians,practicesitesandmedicalgroups.Inmostcases,measuresweredevelopedthroughadaptationofHEDIShealthplan-levelmeasures.Awidearrayoforganizations—healthplans,physiciangroups,offices,communitycoalitions,employers,thepublicsectorandothers—findHEDISPhysicianMeasurementtobeausefulresource.

HEDIS 2011 Technical Specifications for Physician Measurement (Available October 2010) Price

Printedition Item#10273-100-11 $300E-pub1–4users Item#10273-361-11 $265

Volume 1: NarrativeVolume1isanindispensablereferencethatwillhelpyouunderstandthescienceofhealthcarequalitymeasurement.TheNarrativegivesabackgroundonHEDISandexplainswhythemeasuresareimportanttoconsumers,purchasers

andhealthplans.Italsofeaturesuser-friendlydescriptionsofeachperformancemeasureandvaluableguidanceoninterpretingandusingHEDISdata.

HEDIS 2011, Volume 1 (Available July 2010) Price

Printedition Item#10283-100-11 $200E-pubsingleuser Item#10273-301-11 $180E-pub2–4users Item#10273-302-11 $500E-pub5–10users Item#10273-303-11 $1,200

Volume 2: Technical SpecificationsArequiredresourceforanyoneinvolvedincollecting,calculatingorsubmittingHEDISdataforhealthplans,Volume2featuresthecompletetechnicalspecificationsforeachmeasure,includingallrelevantCPT®,ICD-9,HCPCS,UB-92andDRGcodes.Italsoincludesgeneralguidelinesfordatacollectionandreporting,detailedinstructionsonhowtoperformthenecessarycalculationsandguidelinesforsampling.

HEDIS 2011, Volume 2 (Available July 2010) Price


CPT codes copyright 2010. American Medical Association. All Rights Reserved. CPT is a trademark of the AMA. No schedules, basic units, relative values or related listings are included in CPT. The AMA assumes no liability for the data contained herein.

Volume 3: Specifications for Survey MeasuresThisvolumecontainscompleteinstructionsforadministeringallsurvey-basedHEDISmeasures,includingsurveysfromtheConsumerAssessmentofHealthcareProvidersandSystems(CAHPS®)Program.ItincludestheCAHPSHealthPlanSurvey,4.0HAdultVersionand3.0HChildVersion,MedicalAssistanceWithSmokingandTobaccoUseCessation,FluShotsforAdultsAges50–64,FluShotsforOlderAdultsandPneumoniaVaccinationStatusforOlderAdults.Volume3alsoincludestechnicalspecifications,backgroundinformationandprotocolsnecessaryforadministeringsurveysandaccompanyingcorrespondence.

PERFORMANCEMEASUREMENT


HEDIS 2011, Volume 3 (Available October 2010) Price


Volume 5: HEDIS Compliance Audit™ — Standards, Policies and ProceduresNCQAusesonlyauditedHEDISdataforitsinformationproducts,includingQualityCompassandtheStateofHealthCareQualityReport.NCQAAccreditationrequireshealthplanstosubmitauditedHEDISdataannually,whichfurtherstrengthenstheHEDISAuditanditsroleinensuringaccurateandreliabledataforplan-to-plancomparison.HEDIS Compliance Audit Standards, Policies and Proceduresdescribeindetailthemethodologyusedtoauditahealthplan’sdatacollectionprograms,calculationprocessesandHEDISmeasureresults.Thisvolumealsoincludesthestandardsandguidelinesforassessingaplan’sinformationsystemscapabilitiesandforevaluatingitsabilitytocomplywithHEDISspecifications.

HEDIS 2011, Volume 5 (Available November 2010) Price


Volume 6: Specifications for the Medicare Health Outcomes SurveyTheMedicareHealthOutcomesSurvey(HOS)measurewasdevelopedtomonitorandevaluatethequalityofcareandservicesprovidedtoMedicarebeneficiariesandtoprovidethemwithinformationthatsupportsplan-to-plancomparison.Thisvolumefeaturesdetailsaboutthemeasure,thesurveyinstrumentandinformationthathealthplansandvendorsneedtoreportresults.

HEDIS 2011, Volume 6 (Available February 2011) Price


HEDIS 2011 Electronic Coding Tables (ECTs)AvailableinXML,theECTsprovideaneasywaytoincorporateCPT,ICD-9-CM,HCPCS,UB-92andDRGcodesintoyourorganization’sdatacollectionprogramtosaveprogramminghours,eliminatethemanualsearchforcodeandreducekeyingerrors.

HEDIS 2011 ECTs (Available September 2010) Price

Singlesite Item#10289-150-11 $1,9002–5sites Item#10289-151-11 $2,8406–10sites Item#10289-152-11 $3,30011–20sites Item#10289-153-11 $3,78521+sites Item#10289-154-11 $5,645

HEDIS PackageThispackageincludesprintededitionsofHEDISVolumes1,2,3,5and6.Eachpublicationisdeliveredassoonasitisavailable.OrdertheHEDIS2011Packageandsave$115.

HEDIS 2011 Package Price

Item#10283-150-11 $1,020

HEDIS Users Group (HUG) MembershipEachorganizationimplementingHEDISisstronglyencouragedtojoinNCQA’sHUGfortechnicalassistanceandguidanceoninterpretingthespecifications.MembershipbenefitsincludetheHEDIS2011publicationspackage,informationalWeb-basedconferences,amonthlynewsletter,discountvouchersandup-to-datetechnicalinformation,aswellastheinsidetrackonmeasuredevelopment.Twomembershippackageoptionsareoffered.

2011 HUG Package 1ThispackageincludesprintededitionsofHEDIS2011Volumes1,2,3,5and6andasingle-user,memberexclusivee-pubcopyofVolume2thatincorporatesallchangesfromtheOctober Update.Eachpublicationisdeliveredassoonasitisavailable.

2011 HUG Package 1 Price

Item#10702-150-11 $2,495


2011 HUG Package 2ThispackageincludesprintededitionsofHEDIS2011Volumes1,2,3,5and6;asingle-user,member-exclusivee-pubofVolume2thatincorporatesallchangesfromtheOctober Update;andthe2011 Standards and Guidelines for the Accreditation of Health Plans.Eachpublicationisdeliveredassoonasitisavailable.

2011 HUG Package 2 Price

Item#10702-151-11 $2,795

Disease Management (DM)The 2010 DM Standards and Guidelines and Survey Tool are effective July 1, 2010. The 2010 DM program includes performance measures, which are updated each year.

Standards and Guidelines for Accreditation and Certification in DMThispublicationoutlinesstandardsandfeaturesexplanationsandexamplesofhowtomeetthestandards,scoringguidelines,pointsandcertificationoutcomes.Eligibilityrequirements,applicationinformationandpoliciesandproceduresarealsoincluded.

Note: Purchase of the Standards and Guidelines is not necessary if you are purchasing the Survey Tool.

2010 DM Standards and Guidelines Price


Web-based Price

Singleuser Item#10401-321-10 $2352–4users Item#10401-322-10 $4655–10users Item#10401-323-10 $1,150

Survey Tool for Accreditation and Certification in DMTheSurveyToolincludesallinformationneededtoprepareandsubmitmaterialsforanNCQASurvey.OrganizationsapplyingforaccreditationorcertificationmustcompletetheSurveyToolandsubmitittoNCQAtobeginthesurveyprocess.

2010 DM Survey Tool Web-based Price

Singleuser Item#10402-301-10 $9852–4users Item#10402-302-10 $1,9605–10users Item#10402-303-10 $4,885

Technical Specifications for Disease ManagementArequiredresourceforanyoneinvolvedincollecting,calculatingorsubmittingdataforDiseaseManagement.Thispublicationfeaturesthecompletetechnicalspecificationsforeachmeasure,includingallrelevantdataelements.Italsoincludesgeneralguidelinesfordatacollectionandreporting,detailedinstructionsonhowtoperformthenecessarycalculationsandguidelinesforsampling.

2011 DM Technical Specifications e-pub (Available August 2010)

E-pubsingleuser Item#10404-301-11 $160E-pub2–4users Item#10404-302-11 $460E-pub5–10users Item#10404-303-11 $1,080

Application for Accreditation and Certification in DMTheapplicationprovidesallmaterialsnecessarytoapplyforanNCQADMSurveyandincludespricinginformation,policiesandproceduresandthesurveyagreement.

DM Accreditation Application Price

Item#10400-150-02 Free

DM Certification Application Price

Item#10400-151-02 Free

PERFORMANCEMEASUREMENT/ACCREDITATION


Health Plans (HP)The 2011 Health Plan Standards and Guidelines and Survey Tool are effective July 1, 2011.

Standards and Guidelines for the Accreditation of Health Plans Web-based version includes Medicare Advantage. Medicaid is available in a print edition, e-pub and Web-based version.

Thispublicationfeaturesin-depthexplanationsandexamplesofhowtomeetthestandards,accreditationscoringguidelinesandpoints,accreditationoutcomesandreportingcategories.Eligibilityrequirements,applicationinformationandpoliciesandproceduresarealsoincluded.


2011 Health Plan Standards and Guidelines (Available August 2010) Price


Web-based Price


Survey Tool for the Accreditation of Health PlansIncludes Medicare Advantage and Medicaid

TheSurveyToolincludestheStandardsandGuidelinesandallinformationneededtoprepareandsubmitmaterialsforanNCQASurvey.OrganizationsapplyingforaccreditationmustcompletetheSurveyToolandsubmitittoNCQAtobeginthesurveyprocess.

2011 Health Plan Survey Tool (Available July 2010) Web-based Price

Singleuser Item#10801-321-11 $1,3002–4users Item#10801-322-11 $2,4455–10users Item#10801-323-11 $6,110

Application for Health Plan AccreditationTheapplicationprovidesallmaterialsrequiredtoapplyforanNCQAHPSurveyandincludespricinginformation,policiesandproceduresandthesurveyagreement.

Health Plan and MA Application Price

Item#10013-150-10 Free

2011 Health Plan and MA Application (Check website for availability.) Price

Item#10013-150-11 Free

Managed Behavioral Healthcare Organizations (MBHO)The 2011 MBHO Standards and Guidelines and Survey Tools are effective July 1, 2011.

Standards and Guidelines for the Accreditation of MBHOsThispublicationoutlinesstandardsandfeaturesin-depthexplanationsandexamplesofhowtomeetthestandards;accreditationscoringguidelinesandpoints;andaccreditationoutcomesandreportingcategories.Eligibilityrequirements,applicationinformationandpoliciesandproceduresarealsoincluded.


2011 MBHO Standards and Guidelines (Available August 2010) Price


Web-based Price


ACCREDITATION


Survey Tool for the Accreditation of MBHOsTheSurveyToolincludesallinformationneededtoprepareandsubmitmaterialsforanNCQASurvey.OrganizationsapplyingforaccreditationmustcompletetheSurveyToolandsubmitittoNCQAtobeginthesurveyprocess.

2011 MBHO Survey Tool (Available July 2010) Web-based Price


Application for the Accreditation of MBHOsThisapplicationprovidesallmaterialsrequiredtoapplyforanNCQAMBHOAccreditationSurveyandincludespricinginformation,policiesandproceduresandthesurveyagreement.

MBHO Application Price

Item#10026-150-97 Free

2011 MBHO Application (Check website for availability.) Price

Item#10026-150-11 Free

Medicare Advantage (MA)MA ModuleTheMAModuleisanessentialresourceforhealthplansthatprovidecareundertheMAProgram.ThesepublicationssupplementtheNCQAAccreditationSurveywithMedicare-specificrequirementsforthecompleteMASurvey.TheMAModulecontainstheStandardsandGuidelines,datacollectiontools,anappendixofusefulinformationanddetailsabouteligibilityrequirements,applicationproceduresandpoliciesandprocedures.

The MA Module is included in the Web-based Health Plan Standards and Guidelines and the Health Plan Survey Tool.

2010 HP MA Module Price

Printedition Item#10355-100-10 $100E-pubsingleuser Item#10253-331-10 $90E-pub2–4users Item#10253-332-10 $220E-pub5–10users Item#10253-333-10 $575

2011 HP MA Module (Available April 2011) Price


New Health Plans (NHP)The 2011 NHP Standards and Guidelines and Survey Tools are effective July 1, 2011.

Standards and Guidelines for the Accreditation of NHPsThispublicationoutlinesstandardsandfeaturesexplanationsandexamplesofhowtomeetthestandards,scoringguidelinesandpoints,accreditationoutcomesandreportingcategories.Eligibilityrequirements,applicationinformationandpoliciesandproceduresarealsoincluded.


2011 NHP Standards and Guidelines (Available August 2010) Price


Web-based Price


Survey Tool for the Accreditation of NHPs TheSurveyToolincludesallinformationneededtoprepareandsubmitmaterialsforanNCQASurvey.OrganizationsapplyingforaccreditationmustcompletetheSurveyToolandsubmitittoNCQAtobeginthesurveyprocess.

ACCREDITATION


2011 NHP Survey Tool (Available July 2010) Web-based Price


Application for the Accreditation of NHPsTheapplicationprovidesallmaterialsrequiredtoapplyforanNCQANHPAccreditationSurveyandincludespricinginformation,policiesandproceduresandthesurveyagreement.

2010 NHP Application Price

Item#10096-150-98 Free

2011 NHP Application (Check website for availability.) Price

Item#10096-150-11 Free

Wellness and Health Promotion (WHP)The 2009 WHP Standards and Guidelines and Survey Tool are effective April 1, 2009. The WHP program includes performance measures, which are updated each year.

Standards and Guidelines for Accreditation in Wellness and Health PromotionThispublicationoutlinesthestandardsandfeaturesexplanationsandexamplesofhowtomeetthestandards,scoringguidelines,pointsandaccreditationoutcomes.Eligibilityrequirements,applicationinformationandpoliciesandproceduresarealsoincluded.


2009 WHP Standards and Guidelines


Web-based Price


Survey Tool for Accreditation in Wellness and Health PromotionTheSurveyToolincludesallinformationneededtoprepareandsubmitmaterialsforanNCQASurvey.OrganizationsapplyingforaccreditationmustcompletetheSurveyToolandsubmitittoNCQAtobeginthesurveyprocess.

2009 WHP Survey Tool


Technical Specifications for Wellness and Health PromotionArequiredresourceforanyoneinvolvedincollecting,calculatingorsubmittingdataforWellnessandHealthPromotion.Thispublicationfeaturesthecompletetechnicalspecificationsforeachmeasure,includingallrelevantdataelements.Italsoincludesgeneralguidelinesfordatacollectionandreporting,detailedinstructionsonhowtoperformthenecessarycalculationsandguidelinesforsampling.

2011 WHP Technical Specifications (Available August 2010)


Application for the Accreditation of Wellness and Health PromotionThisapplicationprovidesallmaterialsrequiredtoapplyforanNCQAWHPAccreditationSurveyandincludespricinginformation,policiesandproceduresandthesurveyagreement.

WHP Application Price

Item#10893-150-09 Free


Credentials Verification Organizations (CVO)The 2010 CVO Standards and Guidelines and Survey Tools are effective July 1, 2010.

Standards and Guidelines for the Certification of CVOsThispublicationoutlinesstandardsandfeaturesexplanationsandexamplesofhowtomeetthestandards,scoringguidelines,pointsandcertificationoutcomes.Eligibilityrequirements,applicationinformationandpoliciesandproceduresarealsoincluded.


2010 CVO Standards and Guidelines Price


Web-based Price

Singleuser Item#10820-321-10 $2002–4user Item#10820-322-10 $3905–10user Item#10820-323-10 $960

Survey Tool for the Certification of CVOsTheSurveyToolincludesallinformationneededtoprepareandsubmitmaterialsforanNCQASurvey.OrganizationsapplyingforcertificationmustcompletetheSurveyToolandsubmitittoNCQAtobeginthesurveyprocess.

2010 CVO Survey Tool Web-based Price


Application for the Certification of CVOsTheapplicationprovidesallmaterialsrequiredtoapplyforanNCQACVOCertificationSurveyandincludespricinginformation,policiesandproceduresandthesurveyagreement.

CVO Application Price

Item#10006-150-97 Free

Health Information Products (HIP)The 2009 HIP Standards and Guidelines and Survey Tools are effective October 1, 2009.

Standards and Guidelines for the Certification of Health Information ProductsThispublicationoutlinesthestandardsandfeaturesexplanationsandexamplesofhowtomeetthestandards,scoringguidelines,pointsandcertificationoutcomes.Eligibilityrequirements,applicationinformationandpoliciesandproceduresarealsoincluded.


2009 HIP Standards and Guidelines Price

E-pub1–4users Item#10840-311-09 $160

Survey Tool for the Certification of Health Information ProductsTheSurveyToolincludesallinformationneededtoprepareandsubmitmaterialsforanNCQASurvey.OrganizationsapplyingforcertificationmustcompletetheSurveyToolandsubmitittoNCQAtobeginthesurveyprocess.

2009 HIP Survey Tool Price

1–4users Item#10841-321-09 $485

CERTIFICATION


Application for the Certification of HIPsTheapplicationprovidesallmaterialsrequiredtoapplyforanNCQAHIPCertificationSurveyandincludespricinginformation,policiesandproceduresandthesurveyagreement.

HIP Application Price

Item#10842-150-09 Free

Physician and Hospital Quality (PHQ)The 2008 PHQ Standards and Guidelines and Survey Tool are effective October 1, 2008.

PHQ Standards and GuidelinesThispublicationoutlinesstandardsandfeaturesexplanationsandexamplesofhowtomeetthestandards,certificationscoringguidelines,pointsandcertificationoutcomes.Eligibilityrequirements,applicationinformationandpoliciesandproceduresarealsoincluded.


2008 PHQ Standards and Guidelines Price

E-pub1–4users Item#10359-311-08 $215

PHQ Survey ToolTheSurveyToolincludesallinformationneededtoprepareandsubmitmaterialsforanNCQASurvey.OrganizationsmustcompletetheSurveyToolandsubmitittoNCQAtobeginthesurveyprocess.

2008 PHQ Survey Tool Web-based Price

1–4users Item#10356-321-08 $485

PHQ ApplicationTheapplicationprovidesallmaterialsrequiredtoapplyforanNCQAPHQSurveyandincludespricinginformation,policiesandproceduresandthesurveyagreement.

PHQ Application Price

Item#10361-150-08 Free

Utilization Management (UM)/ Credentialing (CR)Note: If you purchased Physician Organization (PO) previously, this is the publication for you.

The 2011 UM/CR Standards and Guidelines and Survey Tool are effective July 1, 2011.

Standards and Guidelines for the Certification of UM/CR Thispublicationoutlinesthestandardsandfeaturesexplanationsandexamplesofhowtomeetthestandards,scoringguidelines,pointsandcertificationoutcomes.Eligibilityrequirements,applicationinformationandpoliciesandproceduresarealsoincluded.


2011 UM/CR Standards and Guidelines (Available December 2010) Price


Web-based Price



Survey Tool for the Certification of UM/CRTheSurveyToolincludesallinformationneededtoprepareandsubmitmaterialsforanNCQASurvey.OrganizationsapplyingforcertificationmustcompletetheSurveyToolandsubmitittoNCQAtobeginthesurveyprocess.

2011 UM/CR Survey Tool (Available December 2010) Web-based Price

Singleuser Item#10808-321-11 $5102–4users Item#10808-322-11 $1,0105–10users Item#10808-323-11 $2,250

Application for the Certification of UM/CRTheapplicationprovidesallmaterialsrequiredtoapplyforanNCQAUM/CRCertificationSurveyandincludespricinginformation,policiesandproceduresandthesurveyagreement.

2010 UM/CR Application Price

Item#10291-150-01 Free

2011 UM/CR Application (Check website for availability.) Price

Item#10291-150-11 Free

NEW! Multicultural Health Care (MHC)The 2010 MHC Standards and Guidelines and Survey Tools are effective July 1, 2010.

Standards and Guidelines for Distinction in MHCThispublicationoutlinesthestandardsandfeaturesexplanationsandexamplesofhowtomeetthestandards,scoringguidelines,pointsanddistinctionoutcomes.Eligibilityrequirements,applicationinformationandpoliciesandproceduresarealsoincluded.


2010 MHC Standards and Guidelines Price

E-pubsingleuser Item#10900-311-10 $200E-pub2–4users Item#10900-312-10 $390E-pub5–10users Item#10900-313-10 $960

Survey Tool for the Distinction in MHCTheSurveyToolincludesallinformationneededtoprepareandsubmitmaterialsforanNCQASurvey.OrganizationsapplyingforDistinctionmustcompletetheSurveyToolandsubmitittoNCQAtobeginthesurveyprocess.

2010 MHC Survey Tool Web-based Price


Application for the Distinction in MHCTheapplicationprovidesallmaterialsrequiredtoapplyforanNCQAMHCDistinctionSurveyandincludespricinginformation,policiesandproceduresandthesurveyagreement.

2010 MHC Application Price

Item#10902-150-10 Free

Abbreviated Standards for Distinction in MHCAhigh-leveloverviewoftheMHCprogram,includingstandardsandelementinformation.Thisdocumentisprovidedforinformation-only.IfpursuingDistinction,purchasetheMHCSurveyTool.

2010 MHC Standards (Abbreviated) Price

Item#10900-301-10 Free

CERTIFICATION/DISTINCTION


Back Pain Recognition Program (BPRP)BPRPidentifiesphysicianswhoprovidehigh-value,patientcenteredcareforbackpain.Theprogramisdesignedwiththeunderstandingthatpatientscanseekcarefromvarioustypesofpractitioners—primarycare,spinespecialists,chiropractors—fortreatmentofanepisodeofbackpain.Accordingly,themeasuresreflectthatphysiciansshouldprovidehigh-qualitycarefromtheoutsetofpatientcontact,andunderstandandconsiderprevioustreatmenthistorytohelpavoidinappropriatetreatment.

Back Pain Recognition Program PackageThisweb-basedpackageincludes2007 BPRP Requirements,aswellasthe2007 BPRP Data Collection Toolandapplication.ThepackagecontainsalltheinformationnecessarytoapplyforRecognition.

Note: Use of the Data Collection Tool is required for Recognition.

2007 BPRP Package Price

Item#10835-151-06 $80

Diabetes Recognition Program (DRP)RewardqualitythroughtheDiabetesRecognitionProgram(DRP)—anationalprogramdevelopedbytheAmericanDiabetesAssociation(ADA)andNCQAthatrecognizesphysicians,physiciangroupsandotherproviderswhoprovidehigh-qualitydiabetescare.ThosewhoearnRecognitionreceivethebenefitofhavingtheirnameshighlightedinproviderdirectories,specialreferralsfromADAandlocalmediaattentionrecognizingtheirachievement.HealthplanscanbenefitbysupportingtheDRPfortheirnetworkprovidersandimplementingRecognitionasanetwork-widequalityinitiative.

Diabetes Recognition PackageThisweb-basedpackageincludesthe2009 DRP Requirements,aswellasthe2009 DRP Data Collection Toolandapplication.ThepackagecontainsalltheinformationyouneedtoapplyforRecognition.

2009 DRP Package Price

Item#10832-321-09 $80

Heart/Stroke Recognition Program (HSRP)TheAmericanHeartAssociation(AHA),AmericanStrokeAssociation(ASA)andNCQAlaunchedtheHeart/StrokeRecognitionProgram(HSRP)—anationalprogramthatrecognizesphysiciansandphysiciangroupswhoprovidehigh-qualitycardiovascularorstrokecare.TheHSRPusesevidence-basedclinicalmeasurestoevaluatephysicianperformance.Physicianswhosuccessfullycompletetheprogramarehighlightedinproviderdirectoriesandgainlocalmediaattentionrecognizingtheirachievement.HealthplanscanbenefitbysupportingtheHSRPasaqualityinitiativefortheirnetworkphysicians.

Heart/Stroke Recognition PackageThisweb-basedpackageincludesthe2006 HSRP Requirements,aswellasthe2006 HRSP Data Collection Toolandapplication.ThepackagecontainsalltheinformationyouneedtoapplyforRecognition.

2006 HSRP Package Price

Item#10826-321-06 $80

Physician Practice Connections (PPC)ThePhysicianPracticeConnections(PPC)Programrecognizespracticesthathavesuperiorsystemsinplaceforconnectingpatientsanddoctorswithinformationandeachother.Useofelectronicmedicalrecords(EMR)isnotrequiredtoachieveRecognition.

Survey Tool for PPC RecognitionTheSurveyToolisaninvaluableresourcecontainingalltheinformationyouneedtoapplyforRecognition.ItincorporatestheStandardsandGuidelinesandfacilitatescollectinginformationabouthowthepracticemeetsthestandards.

Note: Use of the Survey Tool is required for practices applying for Recognition. The Survey Tool includes the complete Standards and Guidelines.

2006 PPC Survey Tool Price

1–4users Item#30001-322-06 $80

RECOGNITION


Physician Practice Connections® (PPC)—Patient-Centered Medical Home™ (PPC-PCMH)NCQA’sPhysicianPracticeConnections®—Patient-CenteredMedicalHome™(PPC-PCMH)RecognitionProgramrecognizesphysicianpracticesfunctioningasmedicalhomesbyusingsystematic,patient-centeredandcoordinatedcaremanagementprocesses.

Physician Practice Connections— Patient-Centered Medical Home Survey ToolThisweb-basedproductincludestheStandardsandGuidelines(therequirementstomeetthestandards,aswellasexplanationsandexamples).TheSurveyToolalsoincludesalltheinformationandtheelectronicDataCollectionToolneededtoprepareandsubmitmaterialstobegintheprocessforRecognition.

2008 PPC-PCMH Survey Tool Price

1–4users Item#30003-322-08 $80

Application for Physician Practice Connections —Patient-Centered Medical HomeTheonlineapplicationincludesanoverviewofthePPC-PCMHProgram,eligibilitycriteriaandpricinginformation.

PPC-PCMH Online Application Price

Item#30002-150-10 Free

Physician Practice Connections—Patient-Centered Medical Home Standards and GuidelinesTheAdobePDFversionofthePPC-PCMH Standards and Guidelinesincludestherequirementstomeetthestandards,aswellasexplanationsandexamples.

Note: Use of the Survey Tool is required for Recognition.

2008 PPC-PCMH Standards and Guidelines Price

Singleuser Item#30003-322-08 Free

Quality Compass®

NCQA’sQualityCompassisanindispensabletoolforselectingahealthplan,conductingcompetitoranalysis,examiningqualityimprovementandbenchmarkingmanagedcareplanperformanceinhealthconditionsmostimportanttoyou.

Quality Compass 2010: Health Care Data to Power ChangeQualityCompassprovidesfullaccesstoplan-specific,comparativeanddescriptiveinformationontheperformanceofhealthmaintenanceorganizations(HMO),point-of-service(POS)plansandpreferredproviderorganization(PPO)plansacrosstheU.S.,inadditiontonationalandregionalperformancebenchmarks.ThisinteractivetoolprovidesonlineaccesstoHEDISandCAHPSdataonmorethan400commercialand100Medicaidpublicreportinghealthplanproducts,generatingcustomizedreportswithgraphicdisplaysandextractingcontentintoMicrosoft®ExcelwiththeoptionalDataExporter.UptothreeyearsoftrendeddataforcommercialandMedicaidplansareavailableforanalyzingperformanceovertime.ThecostofQualityCompassvariesbyformatandnumberofusers.

Formoreinformationaboutpricingandtoviewaproductdemonstrationvideo,visitwww.ncqa.org/QualityCompass.aspx.

RECOGNITION/DATAANDREPORTS


NEW! Quality Compass: RRU + Quality Index (Commercial)Ashealthcarecostscontinuetoskyrocket,healthplans,employersandconsumerswanttoknow:Are we getting the most return for our health care dollars?

Thisyear,NCQAintroducesQuality Compass: RRU + Quality Index (Commercial),whichincorporatesRelativeResourceUse(RRU)measuresthatcapturethetotalresourcesusedbyhealthplanstotreatpatientswithselectchronicconditionsandalignstheirutilizationwiththeirHEDISqualityresults.Thisdatasetprovidesdetailedinformationthatallowsforthecomparisonofplansbasedonbothvalueandquality.

Measuresfocusontraditionallyhigh-costconditions:asthma,cardiovascularconditions,COPD,diabetes,andhypertension.

Populationscapturedintheresourceusemeasuresareriskadjustedforclinicalcategory,presenceofcomorbidities,ageandgendersothatplansthatserveanolderorsickerpopulationarenotatadisadvantagewhencomparedtootherplansthatserveyoungerandhealthierpopulations.

2010CommerciallicensesarescheduledforreleaseinJuly2010andincludeaccesstoRRU+QualityIndex(Commercial),whichisscheduledforreleaseinlateOctober2010.Learnmorebycontactinginformationproducts@ncqa.org

Data Licensing OpportunitiesNCQAofferslicensesforitshealthplanperformance(HEDISandCAHPS)data,accreditationresults,physicianrecognitionprogramsandHEDIStechnicalspecifications.Offeredinvariousformats,thesedatalicensesaredesignedforconsultants,employers,softwarevendors,surveyvendorsandotherhealthcarestakeholdersforvarioususes,includingself-builtreportcardsandbenefitcommunicationtools.Theyaretheperfectcomplementtoanyhealthcareresearchorqualityimprovementinitiative.Availablelicensingoptionsinclude:

Health Plan Performance■ NCQAAccreditationandCertificationresults,

includingWellness&HealthPromotion(WHP)andPhysicianandHospitalQuality(PHQ)

■ HealthcareEffectivenessDataandInformationSet(HEDIS):

• Healthplanperformanceresultsandspecifications

• ElectronicCodingTable(ECT)specifications■ PharmacyQualityAlliance(PQA)measure

specifications■ ConsumerAssessmentofHealthcareProvidersand

Systems(CAHPS):

• Healthplansatisfactionresultsandspecifications

• BlindedcommercialorMedicaidmember-leveldatausingtheHEDIS/CAHPS4.0HAdultSurvey

• AdultandChildCAHPSbenchmarkdata:Totalnumberofcompletedsurveys;nationalpercentilesfortheglobalproportionandcompositemeansforallcompositeandratingmeasures;andfrequencyofsurveyitemresponses

Recognition ProgramsNCQAofferslicensesforitsperformancedataonphysicians,practicesandotherprovidersforintegrationwiththecustomer’sdirectorylistingsandtools.DataincludeidentifyinginformationwithNCQARecognitionProgramstatusfortheBackPainRecognitionProgram(BPRP),DiabetesRecognitionProgram(DRP,ADA),theHeart/StrokeRecognitionProgram(HSRP,AHA/ASA),PhysicianPracticeConnections(PPC)andPhysicianPracticeConnections-Patient-CenteredMedicalHome(PPC-PCMH)*forover15,000recognizedproviders.

* Option to include element level scoring data for each of the PCMH standards.

DATAANDREPORTS


Quality Dividend Calculator™ – Compass EditionTheQualityDividendCalculator™(QDC)–CompassEditionestimatesthesavingsindollarsforemployeepopulationsthatareachievedthroughimprovedproductivityandlowerabsenteeism,basedonhealthplanselection.Byfilteringplan-specificHEDISresultsagainstuser-enteredpopulationcharacteristicsaswellaslaborandwagedata,theQDC–CompassEditiondemonstratesthevalueofselectinghigh-qualityandaccreditedhealthplans.

Thisyear,theQDC–CompassEditionincludesPPOperformancedataforthefirsttime,providingmoreinsightonNCQA-accreditedPPOplansforQDCusers.WhiletheQDC–CompassEditionisavailableforfreetocommercialQualityCompass®users,itisalsoavailableinastandaloneversionthatcanbepurchasedseparately.Manyorganizationsaretakingadvantageofthistooltoarmaccountmanagersandsalespersonnelwithvaluabledatathatdemonstratestheimportanceofplans’achievementsinquality.AfreeversionoftheQDCwithgeneralcomparisons(e.g.,averageAccreditedplanvs.averagenon-Accreditedplan)isavailableatwww.ncqacalculator.com.

FormoreinformationaboutpurchasingthestandaloneeditionoftheQDC,visitwww.ncqa.org/[email protected].

Additional PublicationsState of Health Care Quality ReportProducedeveryyearsince1997,theStateofHealthCareQualityReportisathoroughanalysisandinterpretationofmajorperformancetrendsinmanagedcareoverthepastyear.ThereportlooksatclinicalqualityandmembersatisfactioninformationbasedonHEDISandCAHPSdatasubmittedbyhundredsofhealthplansacrossthecountry.Itincludesnationalandregionalperformanceaveragesandbenchmarksonmeasuresrangingfromchildhoodimmunizationratestomembersatisfactionwithchoiceofdoctor.Thereportexplainsthesignificanceofchangesinthesebenchmarksandtrendsandisavailableonlineatnocost.

2010 State of Health Care Quality Report (Print Edition Available November 2010) Price

Item#80010-100-10 $60

Health Care Quality Improvement Studies in Managed Care Settings—Design and Assessment: A Guide for State Medicaid AgenciesOriginallydevelopedforstateMedicaidagencies,thismanualpresentsaframeworkfordesigning,implementingandevaluatingfocusedqualityimprovementstudiesofhealthcareservices.Itreviewsbasicconceptsofqualityassessment,qualityassuranceandqualityimprovement,andpresentsa10-stepapproachtostudydesignandimplementationwithstudiesofmammography,childhoodimmunizations,prenatalcareanddiabetes.Bibliographyincluded.

Health Care Quality Improvement Price

Item#40011(published1994) $75

DATAANDREPORTS/ADDITIONALPUBLICATIONS


Questions? 888-275-7585Pricessubjecttochange.

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Order Publications and Register for Seminars Online! Orderingisquick,easyandsecure.Onceyourorderorregistrationisreceived,youwillreceiveaconfirmatione-mailwithdetailedinformationaboutthepublication,seminarorproductthatyoupurchased.Visitwww.ncqa.orgformoreinformation.

Mailing Lists TobeaddedtoNCQA’smailinglist,select“ContactUs”atwww.ncqa.org.Youmayselecteducation,newproducts,pressreleases,newslettersandPublicCommentnotifications.

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Effectiveness Dates Effectivenessdatesvary.CallNCQACustomerSupportat888-275-7585withquestionsregardingyourpublicationorder.

NCQA Resource Library NCQAhasanonlineresourcelibrarythatincludesonlineversionsofsomeofitsprintedpublications,whitepapersandnewslettersarchives.Itislocatedatwww.ncqa.orgunder“PublicationsandProducts.”

Archives Lookingforanout-of-datepublication?ContactNCQACustomerSupportat888-275-7585.

Publication and Product FormatsWeb-based Products Theweb-basedproductscontaininstructionsfornavigation,settingupandusingthetoolsforreadinessassessmentandevaluation,managingdocumentsandsubmittingtheweb-basedtooltoNCQA.Nospecialsoftwareisrequired.WerecommendInternetExplorer5.5orhigherasyourInternetbrowser.

E-pubs SomeNCQApublicationsareonlyofferedinthisformat.E-pubsarezipped,protectedWordandExcelorPDFdocumentsthatareeasilydownloadedfromtheWeb.TheyaresimpletoloadontoyourPC,networkandintranet.

User Licenses BothWeb-basedproductsande-pubsaresoldbyuserlevel.Choosethenumberofusersyouneedforyourorganizationandeasilyupgradeifyouneedtoallowaccesstomoreusers.NCQAencouragespurchaseforthelowestlevelofusersneeded;youmayalwaysupgrade,butreturnsandexchangesarenotaccepted.

Printed EditionsSoft-coveredbooksareshippedtoyoudirectly.Producedforthosewholikepapercopies,theabilitytotakenotesorbringthemtomeetingstoshare.

HOWTOORDER


Discounts Thee-pubsandWeb-basedproductpricingstructureincludesavolumediscount;therefore,wecannotextendanydiscountlistedbelow.

Discountsarenotretroactiveandcannotbecombined.Ifmorethanonediscountapplies,thegreaterdiscountwillbegiven.

Volume Discount VolumediscountsareofferedonmostNCQApublications(exceptfore-pubsandWeb-basedproducts).A10percentdiscountisofferedforpurchaseof11ormoreprintededitionsofthesamepublication.Forpurchaseof51ormoreprintededitionsofthesamepublication,contactNCQACustomerSupportat888-275-7585forinformationaboutvolumediscounts.

HUG Members Discount HUGmembersreceiveoneprintedsetofHEDIS2011(Volumes1,2,3,5and6)andasingle-usere-pubversionofVolume2,whichincludesallchangesfromtheOctober Update.HUGmembersreceivea10percentdiscountonpurchasesofoneormorecopiesofHEDISprintededitions,anda10percentdiscountonHEDIS2011e-pubs.TotakeadvantageofyourHUGvouchers,contactNCQACustomerSupportat888-275-7585.

HEDIS Auditor Discount HEDISauditorsreceivea10percentdiscountonpurchasesofoneormoreHEDIS2011printededitions.

Government Discount Employeesofgovernmentagenciesreceivea25percentdiscountofftheregularpriceofallprintededitionsandQualityCompass.Thisdiscountisnotapplicabletoentitiesundercontractwithgovernmentagencies.DeterminationofeligibilityforthegovernmentdiscountisbasedonNCQA’sdiscretion.Torequesteligibilityforthisdiscount,NCQAmustreceivealetteronagencyletterheadrequestingthegovernmentdiscount,priortoprocessing.Thisdiscountisnotretroactiveanddoesnotapplytoonlinepurchasesorinternationalorders.

Purchase Orders NCQAdoesnotacceptpurchaseorders.Prepaymentisrequired.Ifthisposesaproblem,contactNCQACustomerSupportat888-275-7585forassistance.

Returns Aprocessingfeeof15percentofthetotalreturneditemsischargedforallreturns.

NCQAacceptsreturnsofpublicationsanditemsaccompaniedbytheoriginalinvoicewithin30daysofreceiptoftheorder.Returnedprintedpublicationsandproductsmustbeinoriginalcondition.NCQAhastherighttorefuseareturniftheitemisdamagedandnotinitsoriginalcondition.NCQAisunabletoacceptreturnsofe-pubsandWebbasedproducts.

Thereisnoexchangeorrefundfore-pubsorWeb-basedproducts.

Whenreturningorexchanginganitem,completeandattachaReturnandExchangeForm(availableontheNCQAWebsiteorthroughNCQACustomerSupport)withthepackage.BesurethatallpackagessenttoNCQAaretraceableandsentviaUPSortheU.S.PostOffice.NCQAisnotresponsibleforlostpackages.NCQAwillrefundshippingcostsifthereturnisaresultofourerror.Arefundforthecostofthereturneditems,minusa15percentprocessingfeeandexcludingshippingandhandling,willbesentforallreturnsuponreceiptoftheitemandtheNCQAReturnandExchangeForm.

Exchanges AreplacementitemwillbesentoncetheitemandtheNCQAReturnandExchangeFormhavebeenreceived.Ifadditionalpaymentisdue,theitemwillbesentuponreceiptofpayment.CallNCQACustomerSupportat888-275-7585toplaceabalancedueonacreditcard,ormailacheckandacopyoftheNCQAReturnandExchangeFormtoNCQA.

DISCOUNTSANDPOLICIES

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2010/2011PubsCatalog

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Shipping and Handling Rates (Print editions)$25orless . . . . . . . . . . . . . . . . . . . . . . . . . .$10$26–$75. . . . . . . . . . . . . . . . . . . . . . . . . . . .$12$76–$100. . . . . . . . . . . . . . . . . . . . . . . . . . .$14$101–$300. . . . . . . . . . . . . . . . . . . . . . . . . .$18$301–$500. . . . . . . . . . . . . . . . . . . . . . . . . .$22$501–$700. . . . . . . . . . . . . . . . . . . . . . . . . .$28$701–$900. . . . . . . . . . . . . . . . . . . . . . . . . .$34$901–$1,200 . . . . . . . . . . . . . . . . . . . . . . . .$40$1,201–$1,500. . . . . . . . . . . . . . . . . . . . . . .$46$1,501andover . . . . . . . . . .3%oftheordertotalNext Day Service/Overnight DeliveryFirst2publications. . . . . . . . . . . . . . . . . . . . .$50Eachadditional2publications. . . . . . . . . . . . .$45

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PublicationsandProducts

ncqa publications_2010-2011.pdf

Documents

ica t ionsquality compass

plan accreditation