State gives utilization review go-ahead
LOUISVILLE, Ky. (Oct. 4, 2013) – Kentucky Health Cooperative has reached two new milestones: accreditation by the National Committee for Quality Assurance (NCQA), as well as approval by the Kentucky Department of Insurance to conduct medical utilization review.
Kentucky Health Cooperative, a new, nonprofit health insurance carrier, has been certified by the Washington, D.C.-based NCQA for having the “basic structure and processes in place to meet expectations for consumer protection and quality improvement,” according to the NCQA’s certificate. The accreditation status is valid through Feb. 28, 2015.
NCQA is a private, 501(c)(3) nonprofit organization dedicated to improving health care quality, according to its website. The NCQA seal is a widely recognized symbol of quality and will be added to the Kentucky Health Cooperative website. Organizations earning permission to display the seal must first pass a rigorous, comprehensive review and must annually report on their performance. For consumers and employers, the seal is a reliable indicator that an organization is well-managed and delivers high quality care and service, according to the NCQA website.
Kentucky Health Cooperative scored 49.81 points out of a possible 50, said Rick Schultz, Kentucky Health Coop’s vice president of Clinical Care Integration. “We’re very pleased to have scored so well,” he said. “This means our members can be assured of a high-quality experience every step of the way.”
Schultz said Kentucky Health Coop met or exceeded NCQA standards on a variety of operational policies and procedures. These include communications to members; credentialing of physicians and hospitals serving its members; utilization management; quality-improvement, and appeals and grievances.
Accreditation such as that awarded by NCQA is a requirement of the federal Patient Protection and Affordable Care Act. Kentucky Health Coop is established under federal law as a Consumer Operated and Oriented Plan.
The second milestone was the state’s approval of Kentucky Health Coop to conduct utilization review. This means Kentucky Health Coop is authorized to review the use and delivery of medical resources in patient care for purposes of cost control and appropriateness of care.
Janie Miller, chief executive officer of Kentucky Health Coop, lauded the state’s go-ahead regarding utilization review. “Our organization is nonprofit and member-governed. Any surplus revenues will be used solely for improving member health benefits, reducing health premium levels for members, or for other programs intended to improve the quality of health care delivered to members. Utilization management is yet another tool that will help us do right by our members.”
Kentucky Health Coop’s plans are now available on kynect, Kentucky’s Healthcare Connection. kynect is the commonwealth’s new health insurance marketplace, allowing consumers to compare and select insurance plans. There, consumers can find out if they qualify for payment assistance, special discounts or tax credits to help cover the costs of coverage for themselves, their families or their employees.