Talking with Payers, Providers and Patients About Diabetes:
An AAPPO Toolkit for PPOs

Tab 10: Talking with Providers: External Recognition for Quality Care

The National Committee for Quality Assurance (NCQA) is a national non-profit organization that sets standards for managed care organizations. NCQA also manages the Healthcare Effectiveness Data and Information Set (HEDIS), a set of detailed performance standards that establishes performance expectations for health plans. HEDIS performance expectations originate from standards of care from organizations such as the American Diabetes Association, and are reflected in health plan quality requirements and expectations for network physicians. Many health plans offer quality improvement assistance and incentives for physicians.

NCQA also has a physician self-assessment program called the Diabetes Physicians Recognition Program (DPRP). The DPRP offers an auditing protocol to physicians; it identifies where physicians are meeting Standards of Care for diabetes, and areas in need of improvement. DPRP promotes delivery and recognition of consistent high quality care by physicians. It was developed by NCQA in partnership with the American Diabetes Association (ADA). The DPRP is a voluntary program that recognizes physicians who use evidence-based measures to provide excellent care to their patients with diabetes.

This section includes sample information from the National Committee for Quality Assurance:

NCQA Diabetes Physician Recognition Program
http://www.ncqa.org/tabid/139/Default.aspx

What PPOs can say to physicians:

• The DPRP Program has 10 measures based on national Standards of Care covering areas such as:
  • HbA1c control
  • Blood Pressure control
  • LDL control
  • Eye examinations
  • Nephropathy assessment
  • Smoking status and cessation advice or treatment

• Physicians achieve recognition by conducting a self-audit program to evaluate compliance with standards of care; physicians who do not meet initial certification requirements conduct quality improvement activities and when the standards of care are met, can obtain recognition.

• Physicians who achieve DPRP Recognition show their peers, patients and others in the diabetes community that they are part of an elite group that is publicly recognized for providing high quality diabetes care.

• Physician recognition is often used by health plans to pay rewards in “pay for performance” programs, and to identify physicians eligible for preferred status in “tiered” networks. Recognition status is also published in most network provider directories as an indicator to patients that the physician has achieved special status based on quality of services.

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