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How We’re Helping Health Plans Meet The New NCQA Requirements

If you work for a health insurance company, you likely know that July 1 is when NCQA’s Member Connection Standards for Health Plans (or MEM Standards) will begin requiring health plans to be scored for all product lines, including commercial, Medicare, Medicaid, and exchange products.

Why this is happening

The Department of Health and Human Services chose NCQA as an accrediting entity for Qualified Health Plan issuers participating in the Health Insurance Exchange Marketplace. NCQA’s Health Plan Accreditation (HPA) contains all the key elements the law requires.

Additionally, 40 states recognize NCQA Accreditation as meeting their requirements for Medicaid commercial plans, and more than a dozen states mandate it for Medicaid. Medicare deems plans with NCQA Accreditation for Medicare Advantage, and the Federal Employees Health Benefits Program accepts NCQA Accreditation.[1. NCQA, “Health Plan Accreditation,” Nov. 24, 2014, http://www.ncqa.org/Programs/Accreditation/HealthPlanHP.aspx]

How WebMD Health Services is supporting health plans

We know that adjusting to regulatory changes can be challenging. Supporting our clients as the market changes is one of the reasons we began working toward accreditation years ago. In May 2008, we were one of the first companies to achieve certification in several separate areas of NCQA’s Health Information Products (HIP) program. And we’ve been increasing our accreditation ever since. In July, we earned an industry-leading score from NCQA, along with our Wellness & Health Promotion Accreditation.

WebMD Health Services tools are accredited for MEM 1 (Health Risk Appraisals), MEM 2 (Interactive Consumer Health Tools), and MEM 8 (Healthy Living). This means that health plans that partner with us get NCQA auto-credit for those standards.

And we’re excited to report that, as of this week, our disease management programs (asthma, coronary artery disease, heart failure, COPD, and diabetes) have also received full accreditation by NCQA!

This means that our current and new health plan clients can use the tools they license from us to support all lines of business, in time for the July 1 deadline.

Details about the standards

Supporting MEM 1: Health Appraisals (Elements A–G)

Our NCQA-certified Health Assessment combines leading clinical expertise with innovative design to help consumers understand what’s really going on with their health. At the end, we present small, personalized steps that the individual can begin taking right away to live a longer, better life. As with all of our clinical material, the Health Assessment is clinically validated and follows the guidelines of the U.S. Preventive Services Task Force. Health Assessment is available online, on paper, on mobile devices, and over the phone.

Supporting MEM 2: Self-Management Tools (Elements A–D)

Personal Health Record: Personal Health Record is the single repository for self-reported and imported medical information from multiple sources, including medical and prescription claims and health plan information. Our Personal Health Record is the foundation and essential enabler of consumer-driven healthcare, enabling people to take their prescriptions, allergies, vaccination history, and previous doctor visits with them wherever they go.

Digital Health AssistantSM: Our online and mobile coach, Digital Health AssistantSM helps consumers set wellness goals and track their progress. Personalized suggestions drawn from the expertise of WebMD Health Services health coaches help people work toward lifestyle goals at their own pace. Check out the results of a six-month matched-cohort study!

Daily Victory: Daily Victory is a mobile app that helps consumers achieve a sustainable exercise habit by selecting activities and connecting with a small group of supporters to cheer them on. The app is fun and simple, using gamification, social networking, and reward capabilities to keep users engaged.

Weigh Today: Weigh Today is a mobile app that helps consumers establish and maintain a habit of weighing themselves daily. Clever reminders, positive affirmations for weighing in, and the awarding of badges for achievements all help to keep users motivated.

WebMD’s Medical Library:  WebMD’s medical library containing more than 300 health subjects including symptom, treatment, education, and prevention information.

WebMD Guides: Co-developed by WebMD and The Cleveland Clinic, these guides provide in-depth content on some of the most prevalent diseases and conditions.

Supporting MEM 8: Healthy Living (Elements A–B)

Health Program Referral System: This behind-the-scenes piece of technology delivers tailored, personalized wellness recommendations and referrals to the right people at the right time. As a consumer interacts with WebMD tools and we learn more about their health risks, conditions, and preferences, this system will identify, notify, deliver, and maximize participation by eligible individuals to relevant programs provided by WebMD, the health plan, or a third party vendor.

Want to talk NCQA strategy? Don’t hesitate to reach out to us at whsinfo@webmd.net.

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