Quality Measurement Products

Measuring and reporting on health care quality is extremely important; it gives consumers and employers the ability to make informed choices and pursue the best available care. But health care quality assessment is about more than just informing buyers and consumers about their options. It’s also about giving feedback to health plans, medical groups and doctors that they can use to address quality issues and improve over time. That’s NCQA’s mission — to improve health care quality.

There are many different approaches to assessing health care quality: on- and off-site surveys, audits, satisfaction surveys, and clinical performance measurement to name a few. NCQA uses all these approaches in a range of accreditation, certification, recognition and performance measurement programs for different types of organizations, medical groups and even individual physicians. It is through these programs that NCQA is able to gather the quality information we make available to consumers, employers, health plans and doctors. Without such information, quality would improve much more slowly, if at all, and consumers would be forced to make important health care decisions blindly.

The range of evaluative programs offered by NCQA is broad; we offer six accreditation programs, five certification programs and five physician recognition programs. These programs apply to organizations and individuals ranging from health plans including health maintenance organizations (HMOs) and preferred provider organizations (PPOs) to physician networks, medical groups, and even individual physicians. NCQA also offers programs designed for newer health plan options such as consumer-directed health plans. Information generated by these programs helps inform decisions and drive quality improvement.

Accreditation Programs:

Certification Programs:

Physician Recognition Programs:

In addition, NCQA offers several different licensing and certification programs for survey vendors, Healthcare Effectiveness Data Information Set (HEDIS) software vendors and auditing agencies. These programs help ensure the validity of data used in NCQA’s various accreditation, certification and recognition programs.

NCQA also offers a wide array of educational programs and publications outlining requirements for providers and organizations committed to improving quality. These tools become a valuable resource to those developing services focused on delivering improved care each year.

NCQA’s oversight programs are developed using a collaborative model. Input is sought from all interested parties about each of our programs, and a representative advisory committee helps inform development from start to finish. The industry and the public are always invited to comment on our programs as well. These comments often lead to important changes and improvements to our programs.

While the specific standards and performance measures for each assessment program vary to earn NCQA’s seal of approval, participating organizations and individuals must demonstrate that they follow certain quality practices (thoroughly reviewing physicians’ credentials and using qualified staff to review appeals, for example) and meet certain clinical and member satisfaction thresholds (e.g., appropriately screening and controlling members’ blood pressure, encouraging diabetics to have annual eye exams, and customer service). NCQA reviews all data carefully to validate that applicants meet our standards.

NCQA’s programs are voluntary; yet the majority of health plans participate. This is because organizations find value in the programs, both in terms of how they facilitate improvement and because the NCQA seal is a widely recognized symbol of quality among consumers, employers and regulators.

Many of the nation’s largest companies will not offer their employees a health plan that has not earned NCQA Accreditation. And in more than 30 states, health plans that hold NCQA Accreditation are exempted from many or all elements of the annual state audit. Regulators realize that in NCQA-Accredited plans, their quality requirements have already been met or exceeded.

Organizations and individuals that participate in NCQA’s programs and earn the right to use one or more of our quality seals display them with pride, and rightly so. These seals are an indication that they have met the toughest test in the industry. NCQA works to highlight these organizations as well, making detailed results available for free on our Web site. This drives improvement even among the highest achievers.

Making decisions about which health plan or which doctor you want to do business with based on NCQA-supplied information emphasizes to the market that quality matters. Some organizations choose not to participate in our programs. On average, these organizations offer substantially lower quality care and service than their accountable counterparts.

If an organization chooses not to be reviewed by NCQA, there's a simple question to ask: Why not?