Q1: What does HQA stand for?

A1: Health Quality Assessment, a not-for-profit organisation.

Q2: What is the most important reason for HQA’s existence?

A2: HQA was created to develop clinical quality indicators and measurements appropriate for the South African health care industry and to report on these

Q3: Does HQA measure from medical scheme data only?

A3: HQA started measuring clinical quality by using medical scheme data only,  however nowadays HQA also collects data from capitation providers and aims to measure clinical quality at provider level in line with any relevant reforms in the industry and/or needs of members.

Q4: Is HQA private sector focussed only?

A4:  HQA is not private sector focussed only and will therefore also measure clinical quality in the public sector or will support the public sector in that regard. 

Q5: What insights do the HQA results provide?

A5: HQA results provide valuable insights into the accessibility and uptake of healthcare as well as value for money aspects of health care, for example: what is the clinical quality of the health care a person received in relation to the premium contributions they make every month? 

Q6: Who does HQA need to deliver  on its objectives?

A6: HQA believes that a collaborative approach amongst all players with regards to improving clinical quality can contribute towards a more effective and sustainable health care system for all stakeholders. By working together, a more holistic picture of the healthcare system can be seen

Q7: Are there any similar initiatives such as HQA?

A7: HQA has been developed on the example of the NCQA (National Centre for Quality Assessment) based in Washington DC. Internationally, there are a number of initiatives such as HQA as the measurement of health quality indicators is seen as a national priority in many countries

Q8: When was the HQA created?

A8: HQA will be producing its 9th annual Survey in 2013 and  became operational in 2004. 

Q9: To whom are the results of the Survey being released?

A9: The annual HQA Survey is presented in two forums. An Industry Report is presented to all HQA members. In this report participants are not disclosed in the metrics but important trends can be seen. HQA also presents a Scheme Specific Report to each participating scheme in which the scheme can see its own performance in comparison to other non-identifiable participants.

Q10: How safe is a scheme’s data once submitted to HQA?

A10:  Confidentiality of data had been comprehensively addressed in HQA’s contracts with service providers.

Q11: Is HQA trying to point out the the bad guys in the industry?

A11:  HQA does not intent to make anyone look bad, it is also not about finding the guilty. It is much rather a tool and a learning experience for all members whereby clinical quality and value for money considerations can be improved, in the interest of all stakeholders. 

Q12: How could the results of the HQA Survey be used?

A12: The correct interpretation of the results of the HQA Survey is very important and could provide meaningful directive information on aspects such as: benefit design; scheme rules; effectiveness of managed care; provider contracting; member/provider behaviour and education; quality of data, etc. Providers and managed care organisations could also extract meaningful information which could effectively inform and direct their own business strategies and delivery of care.

Q13: Can the HQA results be used for marketing purposes?

A13: HQA currently prohibits the ranking of a scheme to be used in any marketing or media campaigns. HQA does however encourage participants and all other members to disclose their involvement with HQA on their marketing material, web sites and stationary by showing the HQA logo with the wording: “Member of HQA”. HQA has introduced a ‘Certificate of Recognition’ as from 2010 which is publicly awarded to all members and participants each year.

Q14: Is HQA a for profit organisation?

A14: No, HQA is a not-for-profit organisation.

Q15: How is HQA governed?

A15: HQA has a CEO who reports to the HQA Board. Board Members are representative of: medical schemes, managed care organisations, administrators, consumer bodies and academia. HQA also has an audit committee and a risk register. HQA’s accounting and auditing functions are performed by a firm of registered auditors and accountants. HQA’s service providers are reviewed on a three year cycle.

Q16: Is HQA a BHF initiative?

A16: No, HQA is totally independent from any other organisation. BHF is an affiliate member of the HQA and kindly supports the initiative on behalf of members. 

Q17: Is HQA a Towers Watson initiative?

A17: No, HQA has contracted Towers Watson as actuarial and clinical consultants to collect the data from medical schemes and to compile the annual HQA Survey.

Q18: Who else endorses the HQA’s existence and goals and objectives?

A18: HQA’s existence, goals and objectives are endorsed by a number of associated organisations including  the following: Council for Medical Schemes; South African National Consumer Union and the Board of Health Funders.

Q19: Who develops the clinical indicators?

A19: The clinical indicators are developed by the HQA Clinical Advisory Board (CAB) and the Technical Sub-Committee of the CAB. The clinical quality indicators are reviewed on an annual basis.

Q20: How is the Clinical Advisory Board being constituted?

A20: The members of the CAB are invited by the Chairperson to participate in the activities and meetings of the CAB . Members are invited from participating medical schemes, managed care organisations, administrators, provider groups, affiliate members and other parts of the health care industry.

Q21: Are any guidelines being used for developing clinical indicators?

Q21: Guidelines have been drawn up by the CAB and signed off by the HQA Board for use in determining the clinical indicators. Indicators are developed on the basis of: appropriateness; being measurable; availability of data; being reproducible year on year; adding value to the report; driving decisions in managing quality of health care; having a clear evidence-based link from process to outcome; offering a clear indication of a direct measure or a proxy measure; having a clear explanation for its selection, value and method of measure; being linked to a clinical standard or guideline which endorses its use in clinical practice; reflecting the burden of disease in South Africa and being consistent with the HQA philosophy and mission statement.

Q22: Are any classification of indicators being used?

A22: Indicators are grouped into: Ambulatory care; Hospitalisation; Maternity and Newborn and Chronic diseases.

Q23: Do the measurements include clinical outcomes?

A23: Measurements are reliant on available data  and are currently more process focussed. As data become more freely available, accurate and reliable the focus will shift to outcome measurement.

Q24: Who can become a member of the HQA?

A24: Medical schemes and administrators can become Full Members and all other organisations (managed care organisations; health care consultants; employers; business chambers; provider groups; consumer bodies, industry bodies, etc) that could associate with HQA’s goals and objectives can become Affiliate Members.

Q25: What is the difference between full membership and affiliate membership with regards their rights and obligations?

A25: All members receive the annual HQA Industry Report and are invited to the annual Industry Feedback Session. Full members could be elected onto the HQA Board whereas Affiliate Members could be appointed to the Board. All members qualify for being invited onto the Clinical Advisory Board. Full Members submit data for the HQA Annual Report.

Q26: What does it cost to become a member and to participate in the Survey?

A26: For 2012 full membership fees have been set at R8100 for the year and affiliate membership fees will be R16200 for the year. Participation fees for medical schemes will be R16200 per option.

Q27: Why is there a difference in membership fees for Full Members and Affiliate Members?

A27: Full Members also incur significant costs to extract and analyse the data and to participate in the Survey. In addition, Full Members receive scheme-specific Annual Reports which need to be compiled for each scheme.

Q28: How do I become a member?

A28: Contact Louis Botha on 0824535130 or at lj.botha@iafrica.com. Louis will register you as a member and add you to the HQA distribution list. As a member you will receive the annual HQA Industry Report, you will receive the quarterly HQA Communique and you will be invited to all HQA Events. If you are a participating scheme you will also receive your scheme specific report. You could also indicate your preference of involvement whether on the Clinical Advisory Board, at Board level or merely as a participant or observer.