Use of Performance Data
Provider Type
- Physicians
- Participating Physician Groups (PPG)
- Hospitals
- Ancillary
Health Net is subject to various statutory, regulatory and accreditation requirements, and must ensure that all agreements comply with any such mandates. Accreditation from the National Committee for Quality Assurance (NCQA) is critical to both the health plan and network providers and ensures that Health Net meets the highest possible standards of excellence and care.
One of the requirements of NCQA is that Health Net may use practitioner performance data for quality improvement activities. Therefore, Health Net's contract templates have been updated with the following language:
National Committee for Quality Assurance Health Plan Accreditation Standards and Quality Assessments and Improvements. Each Provider agrees to: (i) cooperate with Quality Management and Improvement (“QI”) activities; (ii) maintain the confidentiality of Covered Persons’ information and records pursuant to the Agreement; and (iii) allow the Company to use Provider’s performance data. Moreover, each Provider shall participate in, cooperate with, and its performance shall be measured in accordance with applicable quality measures and criteria, including but not limited to, Company Policies, Office of the Patient Advocate, STARS and External Accountability Set.