Elevate Quality and Improve Performance
NCQA Health Plan Accreditation (HPA) helps health plans improve quality, align operations with requirements that matter to states and employers and strengthen member care and experience. The program is built on a rigorous framework for quality improvement and measurement and bases its results on clinical performance and consumer experience
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Why Health Plan Accreditation?
NCQA Health Plan Accreditation helps organizations:
- Improve operational efficiencies by applying a quality improvement process to key operational areas.
- Satisfy state requirements and employer needs with standards that align with many state requirements and emphasize areas important to employers.
- Support better member experience and health outcomes through a framework that improves areas such as access, care coordination and member connections.
- Demonstrate commitment to quality through one of the most widely recognized Accreditation programs in the country.
A Roadmap for Quality Improvement
Organizations use NCQA standards to conduct a gap analysis and align improvement activities with the areas most important to states and employers, such as network adequacy and consumer protection. Evaluation areas include:
- Quality Management and Improvement.
- Population Health Management.
- Network Management Utilization Management.
- Credentialing and Recredentialing.
- Members’ Rights and Responsibilities
- Member Connections.
- Medicaid Benefits and Services.
How NCQA Helps Health Plans Address Common Challenges
| Core Health Plan Challenges | HPA Solutions |
|---|---|
| Improve quality while controlling costs. | Provides a structured framework for quality improvement and measurement in essential operational areas. |
| Align with state, employer and purchaser expectations. | Standards align with many state requirements and focus on areas important to employers. |
| Uncover and address hidden process inefficiencies. | Standards are used to conduct a gap analysis and identify areas for improvement. |
| Enhance member experience and performance outcomes. | HPA is the only program in the industry that bases its results on clinical performance and consumer experience (HEDIS® and CAHPS®). |
| Navigate Accreditation preparation. | NCQA provides standards, readiness tools, education, policy support and expert resources during the Accreditation journey. |
Ready to take the next step toward Health Plan Accreditation?
Get Started
Understand the Process
See the key steps, process and timing involved in Health Plan Accreditation.
Learn the Process
Review the Standards
Access the standards and guidelines to understand what organizations are evaluated on.
View the Standards
Assess Readiness
Use readiness tools to identify gaps and assess your organization’s survey readiness.
Assess Readiness
Contact NCQA
Speak with an NCQA Representative to discuss your organization’s goals and next steps.
Contact an Expert
Whether your organization is exploring Accreditation, evaluating readiness or preparing for a future survey, NCQA can help you understand the process, identify the right resources and move forward with confidence.
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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