What is NCQA Health Plan Accreditation

Are yous a health plan looking into NCQA accreditation? We know that the procedure can be daunting and often stressful, so we've compiled a list of NCQA basics to help those who are pondering an NCQA accreditation. If yous are a health plan who has already chosen to pursue NCQA accreditation, accept a look at our blog mail service "NCQA Health Plan Accreditation : The Deviation Between Failure and Success." For those of yous just getting started let's swoop into the NCQA nuts, from who the NCQA is to an overview of their Health Plan accreditation levels. Hopefully this list helps bound-start your journey towards successful healthcare accreditation.

What is the NCQA?

The National Commission for Quality Assurance is an independent, non-profit in the United States that is concerned with establishing quality standards for healthcare organizations that aim to place central areas of improvement inside the organizations themselves. NCQA was established in the early '90s, a time in United states healthcare where there was a discernible shift in healthcare reform throughout The Clinton Assistants.

What does the NCQA practise?

The NCQA's programs are voluntary for organizations, physician practices and private physicians – though, their stamp of blessing is widely regarded as a longstanding measure of quality improvement and speaks to an organization's ongoing quality initiatives. They also review wellness plans, and in a competitive healthcare market place, it certainly doesn't hurt to accept accreditation if you want to do business. NCQA review is a rigorous procedure, one that requires planning, dedication and even a bit of elbow grease. Knowing that it is both an economical investment and an investment of time and energy for staff, how can your organization decide if you should undertake NCQA accreditation?

NCQA Health Plan Accreditation

For health plans the NCQA Health Plan accreditation is the gold standard. The NCQA Health Plan accreditation "has helped improve the managed care experience for wellness plans, patients, physicians and employers. Recognizing hundreds of plans that encompass more than 136 million people (43 percent of the U.Due south. population)." The NCQA reviews the plan'southward ability to run across employer demands, industry demands and, arguably nigh of import, consumer demands. Especially now that consumers are 'shopping around' for health insurance coverage, it's never been a more competitive market place for insurers to try to survive in. Federal plans, like Medicare, insist upon the accreditation and forty states in the marriage recognize the accreditation; several dozen mandate it.

NCQA manages several key areas of performance, whether they are evaluating an arrangement, a group of physicians or a wellness programme:

  • Health promotion. Do the activities of the health plan or system promote preventative intendance, work difficult to ensure the return to health of its beneficiaries and is the goal to assistance patients avoid illness?
  • Recovery. Fifty-fifty the best preventative care is unlikely to keep everyone good for you at all times; so, when patients are ill, does the organization or program work hard to get patients back on their anxiety? How do they evaluate and back up new treatments and technologies? Are patients beingness offered the about upwards-to-date care – or are they getting left behind?
  • Chronic Disease. For patients with chronic illnesses, does the organization or program develop proven, long-term strategies for direction of these conditions? Practice patients have access to resource in their communities?
  • Access. Are at that place enough doctors to meet demands of the customs? If patients written report not having access to the care they need, how are these reports handled? What is done to remedy this situation?
  • Qualification. Are the doctors serving the institution the highest qualified and working "to the top of their licensure?" Are physicians and other medical staff routinely evaluated and their credentials checked? Are they required to complete continuing teaching to farther their expertise and experience to assimilate new data and technologies in the rapidly evolving field of medicine?

NCQA Health Plan Accreditation Levels

Excellent: NCQA awards its highest accreditation status of Fantabulous to organizations with programs for service and clinical quality that meet or exceed rigorous requirements for consumer protection and quality improvement. HEDIS results are in the highest range of national functioning.

Commendable: NCQA awards a status of Commendable to organizations with well-established programs for service and clinical quality that run across rigorous requirements for consumer protection and quality improvement.

Accredited: NCQA awards an accreditation status of Accredited to organizations with programs for service and clinical quality that meet basic requirements for consumer protection and quality improvement. Organizations with this status may not accept had their HEDIS/CAHPS results evaluated. If HEDIS/CAHPS results were evaluated, organizations must accept further action to achieve higher accreditation status.

Conditional: NCQA awards a status of Provisional to organizations with programs for service and clinical quality that come across some, but not all, basic requirements for consumer protection and quality comeback. Organizations awarded this condition demand to improve their processes as well as clinical and service quality to reach a higher accreditation status.

Interim: NCQA awards a status of Interim to organizations with basic structure and processes in place to see expectations for consumer protection and quality improvement. Organizations awarded this condition volition need to undergo a new review within 18 months to demonstrate they have executed those processes effectively.

Denied: NCQA denies Accreditation to organizations whose programs for service and clinical quality did non meet NCQA requirements during the Accreditation survey.

*Levels taken from NCQA website

You can find the Health Plan Quality Report Cards here. http://reportcard.ncqa.org/portal/home.aspx

NCQA Health Plan Accreditation Tips