Kaiser’s Earning of Top Quality Grade Serves Dual Marketing Purpose

NCQA Issues Stamp of Approval for Second Time

Quality of care claims have become the industry's biggest marketing obsession -especially among managed care plan execs - and the hardest to prove. At present, one of the aggressive proving grounds is the National Committee for Quality Assurance, the non-profit watchdog group that assesses and reports on the quality of hundreds of managed care plans annually.

Because of the NCQA's three-year, full accreditation earlier this month, Kaiser Permanente of Ohio can now make stronger claims about its quality initiatives.

For the second time, Kaiser earned the NCQA's coveted stamp of approval. The quality coup has a dual marketing incentive, according to Jeff Werner, Kaiser's senior director of marketing. For its larger, national employer accounts, the accreditation is used as a prime selling/marketing opportunity for Kaiser to explain its specific quality initiatives. And for its smaller, local employer accounts, the NCQA stamp of approval is an educational springboard that leads to general discussion about Kaiser's focus on health plan quality.

Putting Quality to the Test During an accreditation review, the NCQA reviews health plans against more than 50 standards focusing on the following six key categories and scoring percentages: Quality Improvement (40% of plan's score): Does the health plan deliver quality of care to its members especially in areas of access, service and response? Physician Credentials (20% of plan's score): Does the health plan meet specific NCQA requirements for investigating the training and experience of all network physicians and keep track of their performance? Members' Rights and Responsibilities (10% of plan's score): How clearly does the plan inform members about how to access health services, choose or change physicians and how to make a complaint? And, how responsive is the plan to members' satisfaction ratings/complaints? Preventive Health Services (15% of plan's score): Does the plan encourage members to have preventive tests and immunizations? Utilization Management (10% of plan's score): Does the plan use a reasonable and consistent process when deciding what health services are appropriate for members' healthcare needs. Is the appeal process for physicians and members effective? Medical Records (5% of plan's score): Do medical records kept by the plan's physicians consistently meet NCQA standards for quality care, demonstrating timely physician follow up? Source: NCQA (http://www.ncqa.org)

So far, this strategy is working. General Motors (Ohio) made Kaiser its health plan benchmark HMO and expressed added support for the plan by decreasing what employees have to pay to use the plan. "NCQA accreditation can be compared to a safety inspection for your car, which involves checking the oil, brakes, etc." said Bruce Bradley, GM's director of managed care plans, commenting on the NCQA's rigorous surveying process for measuring "quality care." And Ohio's School Employee Retirement System renewed its Kaiser contract primarily due to the NCQA accreditation, according to Werner.

Going on Quality Patrol

For the past three years, Kaiser has allowed the NCQA to put its most high-risk, problem-prone and costly clinical services under a microscope to determine quality improvement levels over time, according to Phyllis Powell, director of quality resource management and continuity. The NCQA uses six categories of quality criteria to evaluate health plans like Kaiser on.

Given the intense scrutiny of NCQA surveyors, the quality department alone could not satisfy all of the survey demands. Werner's marketing department, developed case studies, presentations and communications materials for customer relations programs that boosted telephone/appointment access, employee communications and disease specialization.

To prepare for its three-day NCQA on-site review, six work teams were developed to address each standard (about 27.7 of Kaiser's full-time equivalents work on quality initiatives).

A national oversight committee of physicians and managed care experts (assembled by NCQA), looked at several of Kaiser's clinical and service-focused quality initiatives and evaluated them on patient/community needs and whether Kaiser's health care interventions were aggressive enough to meet those needs. Kaiser made significant quality improvements in these areas:

Talking Turkey About HMOs Just in time for Thanksgiving, New York-based Castle Connolly Medical center asks "Is your HMO a turkey?" to promote its new book "The ABCs of HMOS." The book preps the more than 14,000 consumers who join a HMO each day with a checklist of managed care tips, including: Asking if the HMO is accredited by the NCQA. Inquiring about a broad list of primary care physicians and specialists. Asking if the hospitals in the HMO network are the best in the community. (Axel F. Bang Public Relations, 212/929-6059.

• flu and pneumonia immunization programs;
• efforts to decrease C-section procedures;
• screening programs for mammography, cervical cancer and cholesterol;
• telephone access;
• mental health treatment; and
• employee training.

Compared to the first time around, Kaiser's second review process was more straight-forward and objective compared to the first review process which was more subjective. "There was no wiggle room, you either [meet their quality standard] or you don't," said Powell. (Kaiser Permanente of Ohio, Phyllis Powell, 216/479-5353; Jeff Werner, 216/479-5296; NCQA, 202/955-3500)

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