November 29, 2006
Commercial HMO, PPO and Gold reviewed
DANVILLE, Pa.— The National Committee for Quality Assurance (NCQA) has announced that Geisinger Health Plan has received their highest level of accreditation for three separate health plans.
Geisinger Health Plan’s commercial HMO has once again attained “Excellent” Accreditation. Geisinger Health Plan has maintained NCQA’s highest level of accreditation since 1993. In addition, GHP was recognized with a “Quality Plus” distinction from NCQA for care management and health improvement. Quality Plus was introduced as a voluntary program and is designed to identify organizations that adopt innovative practices which promote quality care. The Quality Plus standards emphasize wellness and prevention, management of chronic illnesses, complex case management, physician and hospital performance measurement and other promising strategies for improving health care quality.
For the first time, two additional products were reviewed by NCQA. Geisinger Health Plan Gold Classic and Select, which are Medicare Advantage plans, also received an “Excellent” Accreditation from NCQA. GHP’s Coordinated Care PPO plan received the top accreditation for PPOs with a “Full” Accreditation.
NCQA's highest accreditation is granted only to those plans that demonstrate levels of service and clinical quality that meet or exceed NCQA's rigorous requirements. The commercial and Medicare Advantage plans are reviewed against more than 60 different standards designed to evaluate the health plan's clinical and administrative systems. These standards and performance measures fall into five broad categories: access and service, qualified providers, helping members to stay healthy, helping members to get better and improving care for members with chronic illnesses.
The PPO accreditation process includes reviews of consumer protection, member service, access to care, provider credentialing and medical group oversight before making the final determination of the accreditation.
The NCQA review of all three products consisted of both an on- and off-site component conducted by teams of physicians, other health care providers and industry experts. An independent oversight committee then analyzed the teams' findings and the organization's clinical performance before assigning the accreditation.
“NCQA’s highest accreditations status is reserved for the best health plans in the nation. It is only awarded to those plans that meet or exceed NCQA’s rigorous requirements for consumer protection and quality improvement and deliver excellent clinical care,” states Margaret E. O’Kane, NCQA President. “It also shows that the organization looks after its members’ interests.”
“Accreditation is independent confirmation that Geisinger Health Plan continues to provide its members with some of the best care and coverage in this nation,” says Duane Davis, M.D., the Health Plan’s vice president and chief medical officer. “Our solid network of physicians and their staffs play an integral role in this achievement by delivering the best quality of care to our members and we are extremely thankful to them.”
Begun in 1985, Geisinger Health Plan is one of the nation’s largest rural HMOs and serves approximately 204,000 members in 40 counties throughout northeastern and central Pennsylvania. Plan members have access to complete health-care benefits ranging from preventive care and routine office visits to hospital care and major surgery. Coverage is available for businesses of all sizes, individuals and families, and Medicare beneficiaries. Self-funded and indemnity plans are sold through Geisinger Indemnity Insurance Company. PPO and high deductible plans are sold through Geisinger Quality Options.
The National Committee for Quality Assurance (NCQA) is a private, not-for-profit organization dedicated to assessing and reporting on the quality of managed care plans. NCQA is governed by a Board of Directors that includes employers, consumer and labor representatives, health plans, quality experts, policy makers, and representatives from organized medicine.
NCQA’s mission is to provide information that enables purchasers and consumers of managed health care to distinguish among plans based on quality, thereby allowing them to make more informed health care purchasing decisions. This encourages plans to compete based on quality and value, rather than on price and provider network. NCQA’s efforts are organized around two activities, accreditation and performance measurement, which are complementary strategies for producing information to guide choice.
For more information, please contact
Amy Bowen, Public Relations Coordinator (570) 271-8135