Employers

Employers are vital partners in NCQA’s drive to improve health care quality.

Employer-sponsored coverage is the largest source of health care in the United States. Employers have led the charge to measure and improve health care quality—including the establishment of NCQA in 1990.

Our Employer Relations team engages employers to understand their priorities for providing coverage and how our products can increase the health and well-being of their workforce.

We are committed to providing information and services that clarify employers’ health care choices in a complex and evolving market.

Contact NCQA’s Employer Liaison

RESOURCES FOR EMPLOYERS

Health Plan Accreditation

Hundreds of companies nationwide require that health plans bidding to provide coverage to their employees go through NCQA’s rigorous Health Plan Accreditation.

NCQA Accreditation is the most comprehensive evaluation in the industry, and the only assessment that uses results of clinical performance (HEDIS® measures) and consumer experience (CAHPS® measures).

More than three-quarters of all covered lives (173 million people) are enrolled in NCQA-Accredited plans.

Accreditation is the most common way that employers make use of NCQA’s quality measurement capabilities. But we maintain many other tools for those making purchasing decisions—and tracking performance—at all levels of the health care system.

NCQA Report Cards and Directories

NCQA evaluates people, organizations and groups, and reports the results. This drives improvement, saves lives, keeps people healthy and saves money for employers and other payers.

NCQA maintains report cards and directories for over 20 programs that serve a wide range of health care organizations, practices and individual clinicians.
Some of our most popular programs for evaluating provider performance are described below.

Search results and provider status from all NCQA programs here.

Health Plan Report Cards

Our Health Plan Report Cards evaluate NCQA-Accredited private (commercial), Medicare, Medicaid and Marketplace plans based on:

  • The quality of care patients receive.
  • How happy patients are with their care.
  • Plans’ efforts to keep improving.

Plans receive from 1–4 stars in each of the following areas:

  • Access and Service. Patients have access to needed care, offer good customer service.
  • Qualified Providers. Doctors are licensed; patients are satisfied with their care.
  • Staying Healthy. The plan helps people maintain good health.
  • Getting Better. The plan offers activities that help people get well.
  • Living With Illness. The plan offers activities that help people live well even if they are sick.

Our interactive portal lets users sort plans by state, product type, accreditation level and more.

Health Plan Ratings

NCQA also produces annual Health Plan Ratings that include both NCQA-Accredited and non-accredited plans in the private (commercial), Medicare and Medicaid markets.

Insurer scores range from 0–5, in 0.5 increments, as in the CMS Medicare Advantage Five-Star Quality Rating System. We review nearly 1,500 plans and rate more than 1,000 across three categories:

  • Consumer satisfaction. Patient-reported experiences of care, including experiences with doctors, services and customer service.
  • Prevention. The proportion of eligible members who received preventive services.
  • Treatment. The proportion of eligible members who received recommended care for certain conditions.

Plans earn additional credit for their performance on certain NCQA Accreditation standards.

Find the latest Health Plan Ratings and an archive of past years’ ratings here.

PCMH Recognition Directory

NCQA’s Patient-Centered Medical Home (PCMH) Recognition program is the most widely adopted medical home evaluation program in the country. More than 13,000 practices (with more than 60,000 clinicians) are recognized by NCQA. More than 100 payers support NCQA Recognition through financial incentives or coaching.

Employers use our PCMH directory to evaluate how many primary care practices in a network or health system have earned the NCQA seal—a strong signal of a network’s “patient-centeredness” and a predictor of patient satisfaction.

Employers also use our directory to encourage employees to consider a PCMH when choosing a primary care provider. Our interactive map lets employees find a PCMH near their home or office.

NCQA maintains a repository of PCMH effectiveness studies to help employers understand how they can benefit from encouraging the use of NCQA-Recognized practices.

Other NCQA Programs and Services

Patient-Centered Specialty Practice

A lack of coordinated care between specialty and primary care can lead to inefficiency, waste, poor outcomes and lower patient satisfaction. Integrated care and communication help improve patient outcomes and experience.

NCQA’s Patient-Centered Specialty Practice (PCSP) Recognition helps facilitate team-based care by improving collaboration with primary care and recognizing specialists who streamline and improve care delivery.

NCQA-Recognized PCSPs are ideal partners for primary care PCMHs in building high-functioning medical home “neighborhoods” with strong communication and accountability— important considerations for employers shopping for high-quality networks.

Oncology Medical Home

Oncology Medical Home Recognition evolved from PCSP Recognition. The PCSP standards—which emphasize team-based care, care coordination, care management and population health—are the foundation of Oncology Medical Home Recognition.

Oncology practices can earn PCSP recognition. But our Oncology Medical Home program addresses the extra steps practices take in using a patient-centered approach to treat patients with cancer.

Oncology-specific provisions include requirements that the practice monitor at least six standardized oncology quality measures and adopt evidence-based pathways.

HEDIS Measures and Quality Compass

The Healthcare Effectiveness Data and Information Set (HEDIS®) is the gold-standard for quality measurement in health care.

NCQA has been entrusted with the stewardship of HEDIS measures since the early 1990s. We have expanded the size and scope of HEDIS to include measures for physicians, PPOs and other organizations.

NCQA’s Quality Compass® provides comparative and descriptive performance information on hundreds of private (commercial), Medicaid and Medicare health plan submissions.

The online database is an invaluable tool for employers seeking to evaluate health plan quality and benchmark plan performance on the national, regional and state level. It features up to 3 years of performance trending of HEDIS and CAHPS measures for plans that report performance publicly.

Wellness and Health Promotion Accreditation

NCQA’s Wellness and Health Promotion Accreditation helps employers get their money’s worth when selecting wellness providers by identifying vendors that are likely to deliver on priorities such as improving workforce health and reducing absenteeism.

Organizations that have earned our Wellness and Health Promotion Accreditation are listed here.

Disease Management Accreditation and Certification

NCQA offers a flexible Disease Management evaluation program, including accreditation for organizations that offer comprehensive DM programs to patients or practitioners (or both) and certification for organizations that perform specific functions.

Case Management Accreditation

NCQA’s Case Management Accreditation is a comprehensive, evidence-based accreditation program dedicated to quality improvement. It can be used for case management programs in provider, payer or community-based organizations.

See our directory of NCQA-Accredited Case Management organizations.

EMPLOYER ENGAGEMENT

NCQA values our longstanding relationship with the employer community.

We give employers relevant, actionable information on health care quality. We also rely on the candid input of business leaders to continuously improve our products and develop new ones that meet employer needs.

We welcome feedback and are happy to discuss your questions, concerns and suggestions. Contact us at employerrelations@ncqa.org.

Employer Advisory Council

NCQA convenes its Employer Advisory Council (EAC) twice a year to solicit feedback on current and future NCQA products and services.

The EAC is our main channel to the business community and a valuable source of information on trends and issues in health care.

Learn more  about the EAC, its members and its activities.

 

 

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
CAHPS® is a registered trademark of the Agency for Healthcare Quality and Research (AHRQ).

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