NCQA Accreditation is the Gold Standard in Health Care

NCQA accreditation and HEDIS reporting are vital for health plan providers

Secure Copies of Vaccination Records Now with OMRWhile the launching of the new healthcare Exchange Marketplaces has been accompanied by many glitches, especially on a national level, there is one bright spot. Almost 85 percent of the health plans offered in the Exchange Marketplaces have NCQA accreditation. This means that more Americans should have access to high-quality care from a health plan featuring strong consumer protections. Eventually, all plans in the exchanges will be required to be accredited by an approved national reviewer, but NCQA accreditation is and will likely continue to be the gold standard in health care.

What is NCQA Accreditation?

NCQA stands for the National Committee for Quality Assurance. This is the organization responsible for creating and revising the HEDIS measures that serve as guidelines and benchmarks with respect to various domains of care and the standardized survey process that serves as the basis for HEDIS reporting. A health plan provider that has received NCQA accreditation has passed a rigorous review of its performance across these five areas:
Prevention: Does the plan help patients maintain good health and avoid illness through preventative measures like cancer screenings?
Treatment: Does the plan help people recover from illness using the latest procedures, drugs, and devices?
Management of Chronic Conditions: Does the plan have programs in place for managing chronic conditions like asthma and diabetes?
Access to Care: Are there enough primary care doctors and specialists to go around? Do patients receive timely care?
Quality of Providers: Does the health plan ensure that doctors are licensed and look into any sanctions or lawsuits against them? Are patients happy with their doctors?

Why NCQA Accreditation Matters

NCQA Accreditation helps health plan providers to meet the demands of employers, regulators, and consumers. Many employers will not even consider signing on with a plan that has not been accredited, because they can’t be sure a non-accredited plan will be able to offer the value, performance, and transparency they want for their employees. Regulators in 12 states require plans to have accreditation, and in many other states accreditation is strongly preferred. Finally, consumers like to use NCQA accreditation scorecards as a convenient way to compare plan options and make their purchasing decisions.
If you need help keeping up with the HEDIS reporting required to amass the data used to evaluate performance and ultimately secure accreditation, you can contact HEDIS Nurses for help. We offer expert HEDIS reporting services to help make sure you get your chart abstractions done in a timely and accurate manner.