In the United States, Health Care Accreditation is extremely important, reason being, it validates our health care system by guaranteeing that regulations and rules that control the way we care for our patients and service our facilities are followed.
Accreditation is an evaluation that is carried out externally and internally by healthcare organizations to assess the level of health care based on established standards (Epstein, 2002). Accreditation is an ongoing program that is utilized to implement change to advance the overall performance of a medical facility. Accreditation does not simply involve the setting of standards; it also contains a self-improvement program and counseling. It is crucial to have an accreditation program as it ensures that facilities are run in a safe manner, and patients are provided with the best care. Accreditation does not only cover the medical aspects of a facility; it further tackles safety issues outside of the medical care process (Landon, 2001). Accreditation is a versatile system that deals with all aspects of the healthcare system. Usually, clinics/facilities have teams that inspect particular areas within them; the inspectors carry checklists that give them specific area and items to look into.
The NCQA (National Committee for Quality Assurance) Accreditation appraises the quality of major processes and system health plans provided to their members (Epstein, 2002). The standards are set to assist organizations in achieving the best performance, reducing patient risk, and creating an environment of constant improvement. NCQA appoints a team of trained healthcare experts to conduct a strict on-site survey of every plan considered for accreditation (Epstein, 2002). NCQA accreditation contains standards for utilization management, members’ responsibilities and rights, credentialing and re-credentialing, quality management, and improvement, HEDIS (Health Plan Employer Data Information Set, and CAHPS (Consumer Assessment of Health Plan Services) measures.
NCQA standards assess the following categories. Utilization Management – How consistent, prompt and fair is the plan when it decides on the medical necessity for behavioral health, medical, and pharmacy services. Member Connections – How the plan passes important information to members, that is, their plan resources, health status, cost of prescription drugs and different services. Credentialing – How rigorously the plan investigates practice history and qualifications before permitting a physician to join its network. Members’ Responsibility and Rights – Is the plan clear on how it informs its members on how to use its services and get care. Quality Management and Improvement – A health plan’s strategy for the constant improvement of its services and quality.
NCQA’s strict survey procedure entails offsite and onsite evaluations administered by a team of managed care experts and physicians. Throughout the offsite surveys, NCQA’s appraisers evaluate the plan’s self-evaluation along with other materials presented to NCQA through the ISS (Interactive Survey System). The first Web-Based tool for health plan accreditation is the ISS. It provides feedback and guidance to the plan while simultaneously performing a survey-readiness assessment against NCQA Accreditation standards. The surveyors review the plan’s presented documentation for conformance with the standards.
The standard survey process is continually tweaked to keep a tab on the ever-changing healthcare environment. Established with the support and input of consumer groups, health plans, unions, purchasers, and providers, NCQA standards encourage continuous enhancement of a plan’s value and quality, and the accreditation procedure provides quality health care services to patients. The report card or survey is availed by the NCQA; this offers the patient a chance to shop for and select the best option.
Beaulieu, N. D., & Epstein, A. M. (2002). National Committee on Quality Assurance health-plan accreditation: predictors, correlates of performance, and market impact. Medical care, 40(4), 325-337.
Landon, B. E., Zaslavsky, A. M., Beaulieu, N. D., Shaul, J. A., & Cleary, P. D. (2001). Health plan characteristics and consumers’ assessments of quality. Health Affairs, 20(2), 274-286.
NCQA (2008). Managed Care Organizations, Accreditation MCO. Retrieved on 26 Aug 2015
NCQA Health Plan Accreditation, Retrieved on 26 Aug 2015 from