NCQA Opened Its Doors 25 Years Ago

May 28, 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.

In 1990 NCQA opens its doors as an independent organization, with support from the Robert Wood Johnson Foundation.

A lot of progress can be made in 25 years. Look no further than the way you are reading this blog post. Jokes about a certain vice-president aside, it was actually an English physicist named Tim Berners-Lee who “invented” the Internet in 1990. He, along with the help of colleagues, built on a U.S. military model to define HTML (Hypertext Markup Language), HTTP (Hypertext Transfer Protocol) and URLs (Universal Resource Locators). Those developments brought internet to the masses.

In 1990, Margaret O’Kane, along with the help of colleagues, set off to invent a field dedicated to improving the quality of American health care. They created NCQA. The mission was clear from the beginning. Improve quality by improving knowledge. Measure performance. Then, encourage those delivering care—health plans and providers—to perform better.

In 1990, the entire effort was risky in a way many couldn’t imagine today. Some consumers worried some health plans may withhold care to avoid costs. But the general public, for the most part, accepted the system the way it was. Even more, there was very little—if any—scientific research or record keeping to dispute the assumption that care was uniformly good.

Looking back as NCQA’s founder and current President, O’Kane recalls, “The systems were practically nonexistent. There weren’t many blueprints on the table for quality.”

There were allies in the effort to make sure patients and plan members got the care they needed. NCQA set out to work with seed money from the Robert Wood Johnson Foundation. Two years before, the Foundation had funded a series of meetings to check if businesses and health plans could see the potential of an independent external review organization. The group gave a resounding thumbs up. So the foundation awarded NCQA a grant to open its doors and begin work in April of 1990.

Employers—mainly Fortune 500 companies—were on board too, matching the initial startup grant. They were looking for more efficient health plans to offer their employees. The business world had been conducting its own quality experiments, collecting data on business processes and analyzing it to find improvements. Many thought the success of these experiments could also be used in the health care system.

“Benefit managers were going out and talking to their health plan partners,” O’Kane remembers. “They were saying, ‘Tell us about your quality,’ They would ask questions like, ‘How is your diabetes care,’ and the plan people would say, ‘It’s excellent,’ and then they would say, ‘How many diabetics do you have,’ and the plan wouldn’t know the answer.”

So, O’Kane credits those employers with the NCQA launch. You see, they recognized that no single entity was providing quality reviews for the countless health plans they were choosing from. Most importantly, employers recognized that a neutral third party was what the doctor ordered to cure the quality ills of health care. And so, they got behind this new organization.

Since then, NCQA has found strong support in government and the private sector. It is now the go-to source for defining and driving health care quality policy. The possibilities for the future are seemingly endless because quality improvement is nothing less than a perpetual concept—not unlike the World Wide Web.

So, looking back to 1990, can you imagine what the world would be like without the Internet? Where would American health care be without NCQA?


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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