Why NCQA? The Benefits of Accreditation Abound

By Nancy Ross Bell, RN

Estimated time to read: 3 minutes

The question of "Why NCQA?" often piques the interest of C-suite executives and staff navigating the complexities of accreditation by the National Committee for Quality Assurance (NCQA). As you prepare for surveys or explore new NCQA programs, you'll discover valuable opportunities for growth in healthcare quality. In a time when public trust in healthcare insurers is under scrutiny, achieving NCQA standards assures your organization stands out. MHR discusses the benefits of investing in NCQA accreditation.

The Answers Behind Why NCQA?

The benefits described below are not meant to be all-encompassing. Most importantly, embracing the NCQA Accreditation requirements leads to measurable improvement when organizations take seriously their role in improving healthcare quality. MHR can serve as your trusted partner and expert guide.

Alignment with Standards and Regulations

• Federal and State Compliance: NCQA Accreditation ensures that organizations meet key federal and state requirements, such as claims payment, complaints and grievances management, appeals handling, credentialing, and maintaining provider networks.
• Health Equity Leadership: NCQA is recognized as a leader in Health Equity Accreditation by many states with mandates for health equity, demonstrating its commitment to addressing disparities and improving access to care.
• Delegated Entity Accountability: By adhering to NCQA’s standards for monitoring and evaluating delegated entities, organizations can ensure that business partners remain accountable for fulfilling their responsibilities.

Reputation and Market Advantage

• Attracting Purchasers and Providers: Organizations with NCQA Accreditation are sought after by purchasers and providers who value support for population health-focused delivery systems.
• Employer Preferences: Many employers incorporate NCQA Accreditation into their contracts with health plans, recognizing it as a marker of quality and reliability for their employees.
• Building Trust with Consumers: Promoting NCQA Accreditation and its approach to quality fosters increased consumer trust and loyalty toward health plans.
• Healthcare Leadership Recognition: Displaying NCQA’s seal of approval signals the organization’s status as a trusted and reputable leader in healthcare quality.

Consumer and Member Benefits

• Improved Member Experience: Organizations adhering to NCQA standards for timely access to care and availability help ensure members receive appropriate care with qualified providers within their service areas, enhancing satisfaction.
• Consumer Confidence: Increased awareness of NCQA Accreditation builds confidence among members and patients, reinforcing their trust in the organization’s commitment to quality care.

Quality Improvement and Operational Efficiency

• Evidence-Based Decision Making: Accredited organizations incorporate the latest evidence-based practices into utilization management and case management, improving care outcomes.
• Data-Driven Improvement: The qualitative and quantitative analysis required by NCQA standards promotes sound, data-informed decisions that improve quality and enhance population health management.
• Streamlined Processes: NCQA encourages thoughtful design of policies and procedures, reducing administrative burdens by eliminating redundancies, focusing on high-value actions, and clearly defining accountability.
• Enhanced Care Coordination: NCQA’s standards for integrating medical and behavioral healthcare coordination improve communication between practitioners and across care settings.
• Cost Reduction: By optimizing operational processes and eliminating inefficiencies, organizations may achieve significant administrative cost savings while improving service delivery.

Organizational Culture and Employee Engagement

• Corporate Goals and Structure: Achieving NCQA Accreditation offers organizations a framework for use in performance evaluations, tying incentives to measurable quality improvements and fostering accountability.
• Process Improvement Culture: The emphasis on continuous quality improvement benefits not only the organization but also its members by enhancing care delivery and operational processes.
• Employee Recognition and Satisfaction: Engaging employees in quality improvement initiatives and recognizing their contributions fosters job satisfaction and reduces turnover, creating a more committed workforce.

Risk Management and Continuous Improvement

• Proactive Risk Mitigation: Organizations can identify and address gaps in their processes by leveraging NCQA’s validated standards, helping prioritize work to avoid potential risks.
• Mock File Audits: Conducting regular mock audits helps uncover areas of non-compliance, allowing organizations to refine their processes before formal survey evaluations.

Next Steps

If you're considering NCQA Accreditation for the first time or expanding into areas like NCQA Health Equity Accreditation, MHR is here to help! With 34 years of experience, our team provides guidance, starting with a comprehensive Gap Assessment, identifying risks, and prioritizing actions. We won’t sugar-coat our findings! We will let you know what may be missing and what actions you can take to comply with the standards.

We offer training programs on the NCQA standards, analysis, and delegation. Our new train-the-trainer program for file reviews gives organizations the knowledge to train their teams on conducting regular file audits.

If the complexity of data collection and analysis is a concern, MHR offers a library of tools and templates that meet the NCQA standards so you are confident in your reporting.  

Take us along on your journey to achieving a high-quality organization, as evidenced by your NCQA Accreditation status. Our team of highly experienced independent consultants who have worked in senior roles in various organizations across the US is here to help get you there.

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Not all NCQA Consulting firms are alike. Click on our checklist for points to consider when choosing an NCQA Consulting firm.

Considerations When Choosing an NCQA Consultant

Call to Action  

•  Read How We Work to understand how MHR is dedicated to helping organizations realize the benefits of NCQA Accreditation.
•  Review our Products page for a listing of NCQA Training by the MHR Consultants and MHR’s proprietary Tools & Templates available for purchase for clients and non-clients.
•  Read MHR’s Blog on: Get A Full Gap Assessment Before Your NCQA Survey