1991: NCQA’s First Managed Care Organization Accreditation

June 4, 2015 · NCQA

25 for 25: A series of 25 blog posts marking NCQA’s 25th anniversary. As part of our anniversary celebrations, NCQA will post a series of 25 blog posts highlighting milestones in our 25 years of improving health care quality.

1991: First Managed Care Organization Accreditation

The search for our first accredited Managed Care Organization (MCO) turned out to be a bumpy one. It quickly dissolved into a game of Clue™.

Even the term MCO is a mystery to many. An MCO is an organization responsible for the management and administration of health care benefits to patients. Most of us participate in these organizations as plan members. You likely know yours as a “HMO” or “PPO.”

Mystery #1: Identifying Our First Accredited MCO. We knew the year–1991. But because the world has become largely digital since then, the challenge became reviewing records. There were no electronic trails to follow. Luckily enough, some long-serving NCQA staff and surveyors pieced together the clues for us. Their paper trail confirmed NCQA’s first MCO accreditation survey team evaluated Health New England. It happened on Wednesday, January 16, 1991. Those veterans recall it because Operation Desert Storm—the first war in Iraq—started the next day.

Mystery #2: Decoding the survey process. That long, paper-lined trail also revealed some clues about the original survey process and its evolution to the much more broad, but efficient and quicker process it is today.

At the beginning, it was labor-intensive. NCQA veterans recall a flurry of color-coded “paper data collection tools” in which each color represented different accreditation standards. Each physician and administrative surveyor supplemented the colored sheets with his or her own set of handwritten notes. The administrative surveyor duplicated the information using a mimeograph machine – the noisy predecessor to the copy machine.

It took four long days and a survey team comprised of two physicians and two administrators to compile approximately 50 to 100 binders loaded with color-coded papers. The people who were there all described those binders the same way—heavy. The final report turnaround time for a typical survey took three to six months.

Compare that to today’s typical survey. It takes one to two days. There are just two administrators. Almost no paper is involved and the final report is usually finished with 45 days. And now—just in time for our 25th Anniversary–we’ve replaced our old Interactive Survey System (ISS) with the 2015 Interactive Review Tool (IRT). IRT is designed to streamline data collection. All indications are that the people who submit data are much more satisfied.

Mystery Solved. So, we learned the accreditation process has evolved over the years. Our search revealed it now takes a lot less time and paper to cover a broader array of issues in pursuing better quality health care. It also revealed our NCQA staff is much more focused on improving quality’s future than archiving its past.

A special thanks to Health New England in taking bold steps as an early adopter of health care quality, and to the surveyors who started it all:

Administrative Surveyors: Margaret E. O’Kane and Pam Anderson
Physician Surveyors: David Siegel, MD, Maureen Mangotich, MD and Joe Stankaitis, MD.


A cornerstone of NCQA’s 25th anniversary year will include a look ahead through the eyes of tomorrow’s leaders. This November 9, NCQA will convene Quality Talks: Inspiring the Future of American Health Care, a “TED-style” symposium held at the Knight Conference Center at the Newseum in Washington, DC. bringing together hundreds of health care and public policy professionals, including government regulators, thought leaders and Congressional staff.

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