Is NCQA Accreditation Right for You?

In the alphabet soup of healthcare accreditation, chances are there are at least one or two accrediting bodies that you aren’t entirely sure about – one of those might be NCQA. Who are they, what do they accredit and do you need their accreditation in your organization?

In the alphabet soup of healthcare accreditation, chances are there are at least one or two accrediting bodies that you aren’t entirely sure about – one of those might be NCQA. Who are they, what do they accredit and do you need their accreditation in your organization?

Who is NCQA?

The National Committee 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 identify key areas of improvement within 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 Administration.

What does NCQA do?

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

Do we need NCQA accreditation?

For health plans, anyway, NCQA is the gold standard. Their review will evaluate the plan’s ability to meet employer demands, industry demands and, arguably most important, consumer demands. Especially now that consumers are ‘shopping around’ for health insurance coverage, it’s never been a more competitive market for insurers to try to survive in. Federal plans, like Medicare, insist upon the accreditation and forty states in the union recognize the accreditation; several dozen mandate it.

NCQA manages several key areas of performance, whether they are evaluating an organization, a group of physicians or a health plan:

• Health promotion. Do the activities of the health plan or organization promote preventative care, work hard to ensure the return to health of its beneficiaries and is the goal to help patients avoid illness?

• Recovery. Even the best preventative care is unlikely to keep everyone healthy at all times; so, when patients are sick, does the organization or plan work hard to get patients back on their feet? How do they evaluate and support new treatments and technologies? Are patients being offered the most up-to-date care – or are they getting left behind?

• Chronic Illness. For patients with chronic illnesses, does the organization or plan develop proven, long-term strategies for management of these conditions? Do patients have access to resources in their communities?

• Access. Are there enough doctors to meet demands of the community? If patients 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 education to further their expertise and experience to assimilate new information and technologies in the rapidly evolving field of medicine?

For Accountable Care Organizations, NCQA accreditation only stands to further prove your organization’s intent to commit to quality improvement initiatives, ongoing staff education and your accountability to patients in your community. These are noble values for any business – but especially in healthcare where it’s no longer enough for a hospital and its providers to be “good” – you’ve got to be great if you want to compete.