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Health Plan Accreditation for Employers

More than 116 million Americans (70.5% of all health plan members) are covered by an NCQA-Accredited health plan.

  • 90% of health plans report HEDIS data.
  • 32 states collect or require HEDIS performance data.

NCQA Health Plan Accreditation helps employers and consumers distinguish between health plans based on quality and value. Accreditation uses a unified set of standards for HMOs, MCOs, PPOs and POS plans.

Accreditation evaluates not only the core systems and process that make up a health plan, but also the actual  results that the plan achieves on key dimensions of care, service and efficiency. A rigorous survey process involves onsite and offsite evaluations conducted by a survey team of physicians and managed care experts.

The onsite survey is a two-day visit, during which trained NCQA surveyors—including physicians—interview plan staff and review materials that cannot be submitted electronically, such as case records, meeting minutes and other confidential documents.
NCQA’s Review Oversight Committee (ROC), a national panel of physicians, analyzes the survey team’s findings and assigns an accreditation status based on the plan’s compliance with NCQA standards and its performance on selected HEDIS measures, relative to other plans.

Developed with the input and support of health plans, purchasers, unions and consumer groups, NCQA standards are demanding, encouraging continuous enhancement of a plan’s quality and value.

Report Card & Rankings
Use our report cards and rankings to locate the health plan that's right for you and your organization.

About Other Delivery Systems

Private Health Exchanges
Private health exchanges are growing. Learn how employers can build quality into private health exchanges.

Wellness & Health Promotion
Learn which wellness programs meet the nation's highest standards for value and quality.

Disease Management
Find a disease management vendor that is efficient, has high customer satisfaction and delivers better health outcomes.

Finding Good Primary Care
Quality care begins at "home": the Patient-Centered Medical Home. NCQA has the most popular medical home program in the country.