THE VALUE OF NCQA ACCREDITATION FOR HEALTH PLANS

The search for value in health services reflected by increasing quality and decreasing costs was the foundation by which NCQA was formed. However, some organizations still question the value of NCQA because of needing resources for other areas, such as expanding its markets, growing into new products and services, and adopting new technology.

It is critical to organizations that leadership supports a culture of quality improvement and recognizes that NCQA Accreditation builds accountability for quality healthcare delivery, patient safety, and effective utilization of resources.

This blog is the first of three on the topic of the value of NCQA. We look at NCQA standards within the well-recognized framework of the Quadruple Aim of healthcare and how value is recognized using the NCQA Health Plan Ratings and NCQA Seals.

In the second Blog on value, we will discuss the use of NCQA standards as evidence-based practices and a comprehensive framework for quality improvement and give examples of value gained from the implementation of NCQA standards.

In the third Blog on value, we will present how investing in employee training is a value-added strategy and highlight MHR’s 2023 Training products.

The Pillars of Quality are Shared among NCQA, Health Plans, and Providers in the Quadruple Aim framework

In this graphic, NCQA Health Plan Accreditation standards are categorized within the four pillars of the Quadruple Aim, demonstrating shared goals among NCQA, health plans, and providers, including improving health outcomes and member experience, reducing costs, and promoting the well-being of teams. Value is gained when organizations are mindful of these common goals when seeking to expend resources on new markets, products, services, and technology.

NCQA Program Seals are Recognized Symbols of Quality

One way health plan quality is recognized publicly is by a specific program seal that NCQA designates for use according to the organization’s earned accreditation status and Stars rating. The Stars ratings are updated annually depending on the results of HEDIS and CAHPS performance measures and the NCQA Seal is updated dependent on the organization’s accreditation cycle. The NCQA report cards are available to the public for transparency and can be found here. 

NCQA Seals are symbols used widely by health plans in advertising, marketing campaigns, and health-related materials to show members they follow best practices and signals that its executive team and employees are committed to high-value quality healthcare and service.

NCQA Seals can change annually depending upon HEDIS and CAHPS performance measures, whereas points earned on standards during an accreditation survey are constant until the next survey cycle (generally three years). Therefore, organizations must strive to maximize accreditation points and avoid not meeting scores.

Maximizing accreditation points is achievable by:

• Sharing your corporate goals on accreditation with all employees
• Ensuring that business decisions consider growth and innovation
• Involving appropriate people with expertise when making decisions including external consultants
• Communicating from the top that the joint effort of everyone is needed to achieve the highest score for accreditation
• Planning in advance
• Avoiding common pitfalls

 How to say it? A high Stars Rating and Accredited Status show our members and our competition that our organization is committed to high-value quality care and service. Our NCQA Accreditation Seal is a symbol of quality.

Call to Action:

• Verify how your organization incorporates health outcomes, member experience, costs, and provider/team well-being into its corporate goals.
• Check how your organization displays and uses the NCQA Seal in advertising and marketing. Refer to NCQA’s guidelines for more information on the proper use of the NCQA Seal:

Our discussion on the value of NCQA Accreditation was prompted by questions in some organizations on its benefits. In this first of a three-part discussion on value, we began by showing how the NCQA standards fit within the framework of the Quadruple Aim, which demonstrates common goals, and how value is recognized by the NCQA Seal. We offered how to say it to help you verbalize the benefits of NCQA Accreditation and suggested a call to action.

With that said, know that MHR knows the value of NCQA as we live it, day in and day out. The MHR team adds value to your organization by guiding you, side-by-side, throughout the survey preparation process to achieve that coveted NCQA Seal.