Health Plan Accreditation Benefits & Support

Health Plan Accreditation benefits impact operational performance and marketplace competitiveness. Organizations seeking Accreditation receive resources and support to help them during and after the evaluation process.

How Does My Organization Benefit?

  • Use the NCQA Health Plan Accreditation standards to perform a gap analysis and determine improvement areas. They provide a framework for implementing evidence-based, best practices to help plans improve in areas of:
    • QI process.
    • Population health management.
    • Practitioner network and access to care.
    • Utilization management processes.
    • Credentialing and recredentialing processes.
    • Members’ rights and responsibilities.
    • Member connection.
    • Medicaid service requirements.
  • Satisfy state requirements and employer needs. The standards align with many state requirements.
  • Keep patients happy and healthy. The standards provide a framework for improving key impact areas.
  • Demonstrate your commitment to quality.

NCQA Plans Perform Better

Based on health plan ratings on key HEDIS measures, NCQA-Accredited Medicare Advantage and Medicaid plans perform better in areas of treatment and prevention than non-accredited plans.

Medicare Advantage Plan Performance

NCQA Accreditation is widely used and respected because it gets results. More than 11 million Americans are members of NCQA-Accredited Medicare Advantage plans.

  • Ten of the fourteen 5-star plans in the 2017 Medicare Part C and D Star Ratings hold NCQA Accreditation.
NCQA-Accredited Plan Rated Highly Nonaccredited Plan Rated PoorlyNonaccredited Plan Rated Poorly
PREVENTIONThree times more often. Twice as often.Twice as often.
TREATMENT39% more often. Almost nine times more often.Almost nine times more often.

Rated Highly = health plan rating score of 4+ / Rated Poorly = health plan rating score <2

MEDICAID PLAN PERFORMANCE

NCQA Accreditation is widely used and respected because it gets results. More than 39 million Americans are members of NCQA-Accredited Medicaid plans.

  • In a consumer-driven Medicaid landscape, it is essential that managed MCOs engage members in their care. NCQA’s standards emphasize a member-centric focus, guiding plans to connect with their members for appropriate utilization of benefits.
NCQA-Accredited Plan Rated Highly Nonaccredited Plan Rated Poorly NCQA-Accredited Plan Rated Highly Nonaccredited Plan Rated Poorly
PREVENTION100% - All plans were NCQA-Accredited. Twelve times more often.100% - All plans were NCQA-Accredited. Twelve times more often.
TREATMENTAlmost five times more often. Eighteen times more often.Almost five times more often. Eighteen times more often.

Rated Highly = health plan rating score of 4+ / Rated Poorly = health plan rating score <2

WHERE CAN I FIND RESOURCES?

You can find more information about the Health Plan Accreditation in the following:

  • Standards and Guidelines: Provides the complete descriptions of the standards, including the intent and scope of the review.
  • Interactive Review Tool: includes the complete standards and guidelines and allows your organization to determine its readiness for a survey.

ADDITIONAL SUPPORT

  • The Policy Clarification Support (PCS) system, My NCQA, and FAQs can help you interpret NCQA standards.
  • Policy Updates: Lists corrections, clarifications and policy changes to our stated Standards and Guidelines.
  • Accreditation and Certification Users Group: An innovative and interactive community for customers of NCQA’s Accreditation, Certification and Distinction products.
  • HEDIS Users Group: An interactive and informative community for those working with HEDIS to receive the most up-to-date information.
  • Education and Training: NCQA offers a variety of training options, from on-demand web-based programs to live in-person seminars.
  • Advertising Guidelines: Designed to help customers create clear, factual and accurate advertising and marketing materials.
  • Seals: Created to provide print-friendly graphics for use in promoting the NCQA status.
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