Below are brief descriptions of some of the ways states utilize our products and technical expertise to drive health care quality. For more information or to discuss your state’s needs, contact NCQA State Affairs.
Healthcare Effectiveness Data and Information Set Measures (HEDIS®): Our HEDIS® quality measures are the foundation of many state-operated quality reporting and value-based payment programs. A number of states require plans in the Medicaid and commercial spaces to report HEDIS data to NCQA. We also provide measure development services and technical assistance to states (and the federal government).
Health Plan Accreditation (HPA): 3 out of 4 states that use managed care plans to provide Medicaid services either require plans to be accredited by NCQA (26 states) or accept NCQA HPA as part of a broader accreditation requirement (5 states). Several states also “deem” plans that have been accredited by NCQA as meeting federal program standards under the Medicaid Managed Care Rule’s “non-duplication” provisions.
Long-Term Services and Supports (LTSS) Distinction for Health Plans: With over 5 million individuals receiving LTSS through Medicaid managed care – and that number increasing rapidly – NCQA felt compelled to create a module to our Health Plan Accreditation product that would set the bar for high-quality care for this vulnerable population. Within a year of its launch, a handful of states had begun rewriting managed care contracts to ensure that plans were held to our new LTSS standards.
Patient-Centered Medical Home (PCMH) Recognition: NCQA maintains the most widely-adopted Patient-Centered Medical Home evaluation program in the country. States see great value in building their delivery system reform models on a PCMH base and coordinating with other public and private organizations on multi-payer PCMH initiatives that incentivize and/or require practices to go through NCQA’s program. We also offer auto-credit toward PCMH recognition to practices that are participating in the federal Comprehensive Primary Care Plus (CPC+) program.