NCQA is a private, independent non-profit organization founded in 1990. NCQA is dedicated to improving health care quality and committed to measurement, transparency and accountability at all levels of the health care system.
Accreditation and Certification Programs
NCQA accredits and certifies a wide range of health care organizations, including health plans and organizations that address disease management, credentials verification and other areas of care. To earn the NCQA seal, participating organizations must demonstrate that they follow certain quality practices—such as using qualified staff to review appeals and taking steps to ensure its members have access to care—and meet clinical quality and member satisfaction thresholds. NCQA Accreditation is widely recognized as the most rigorous and comprehensive in the industry. Accredited health plans must annually report on their performance. For consumers and employers, the seal is a reliable indicator that an organization is well-managed and delivers high quality care and service.
Today, 3 out of 4 Americans enrolled in an HMO are in an HMO accredited by NCQA, and more than 90 percent of managed care organizations report quality data through HEDIS®, NCQA’s set of clinical quality measures that are the most widely used in the health care industry today.
- As of August 31, 2007, 221 commercial health plans, 59 Medicaid plans and 74 Medicare plans are accredited by NCQA.
For a complete list of NCQA-Accredited health plans, please visit http://hprc.ncqa.org. Additionally, the Report Cards section of our Web site includes report cards for all NCQA programs, including certification.
Health Plan Accreditation
On September 13, 2007, NCQA announced 13 PPOs, covering 10.2 Americans, that are the first to come forward for NCQA's new Health Plan Accreditation standards. The program evaluates PPO and managed care plans under a common set of standards, allowing consumers, employers and other purchasers of health care to make understandable, reliable comparisons among different types of health plans to better inform their health care choices. To read more about Health Plan Accreditation and to see a list of the 48 major employers endorsing the program, click here.
Physician Recognition
Simply put, some doctors are more effective than others in treating particular illnesses. As a result, NCQA developed a series of Physician Recognition programs to help people find doctors that consistently treat patients according to the best available scientific evidence. More than 5000 physicians have earned NCQA Recognition; our RP programs form the basis of quality improvement programs nationwide.
Doctors who participate in Physician Recognition programs tend to improve the quality of care they provide quite rapidly. Professional ethics is a strong motivator throughout the field, and doctors who identify opportunities for improvement typically change practice patterns and make improvements quickly. Among doctors who participate in the Diabetes Physician Recognition Program, rates for nephropathy screening, lipid screening and control and blood pressure control (<140 mg) all improved between 50% and 100% within five years, a much faster rate of improvement than among health plans.
NCQA has helped to build consensus around important health care quality issues by working with large employers, policymakers, doctors, patients and health plans to decide what’s important, how to measure it, and how to promote improvement. That consensus is invaluable — transforming our health care system requires the collected will and resources of all these constituencies and more.
For a complete list of NCQA Recognized physician, visit the Recognized Physician Directory at http://recognition.ncqa.org.
For more detailed information, please visit the About NCQA section of our Web site.