Accreditation & Quality: The Truth is In the Data

March 9, 2020 · Jazmyne Carter

The data tells the story. Quality measurement makes a difference—a big one.

Don’t take our word for it. American Health Insurance Plans (AHIP) says so.

An AHIP study analyzed Medicaid managed care plan performance for HEDIS® and CAHPS® quality measures between 2014 and 2018. You can bet we liked what they found. It’s another confirmation of what we’ve been promoting for a very long time—the power of accountability.

We love when the data backs us up to confirm the three simple concepts for our quality improvement objectives. Measurement. Accountability. Transparency.

Quality Measures

NCQA measures influence health plans. That’s the glaring message from the AHIP study.

Within a five year period, Medicaid managed care plans improved performance on 26 of 30 HEDIS and CAHPS measures. The measures included everything from controlling high blood pressure to comprehensive diabetes care. We believe it’s simply because the plans measured, and then used the results to guide quality improvement over several years.

On top of that, NCQA uses this very data to inform our own health plan ratings. So, plans are driven to improve their “public” record.  We hold them accountable because in addition to our accreditation, we publicly share our analysis.

And yet, a growing number of  healthplans still seek and obtain NCQA Health Plan Accreditation. They seek our robust review of their performance.

In 2018, 77% of Medicaid managed care enrollees were members of NCQA-accredited plans. That’s up from 71% just three years earlier.

Quality Rewards

It’s not a coincidence that value-based care and other alternative payment models expanded during the period included in the study Yes, the ultimate reward is improved health outcomes, but who doesn’t want a bonus or two?

States increasingly use quality-related bonus payments, quality withholds, and/or preferential auto-assignment of enrollment for those who meet the quality targets. Medicaid managed care plans’ base their contracted payment arrangements with primary care practices, specialists and hospitals on the very same target metrics.

So, great job Medicaid managed care plans! You promote high quality care—care based on quality measurement.

The study shows quality measurement and HEDIS measures work. It shows NCQA Accreditation is a valuable pursuit. It shows both increasingly earn clinical and financial rewards.

We love when a plan comes together.





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