NCQA accreditation standards help health plans and other organizations align future initiatives with issues that are front and center for employers and states. These categories include utilization management, member connections, Medicaid services and benefits, quality improvement, network management, member rights, population health management, and credentialing. NCQA places important weight on measuring participant-rated experience and health outcomes. Accredited organizations are committed to best-practices and quality measures.
As you can imagine, seeking accreditation is a rigorous process – one made easier by using a health risk assessment (HRA) that has been vetted for quality by NCQA.
How to begin the NCQA Accreditation process
Health Plan Accreditation requires the use of HRAs and self-management tools. Companies can develop their own, buy existing products, or contract with a third party for those services. CoreHealth Technologies wrote a helpful article to help you weigh out the pros and cons of building an HRA or self-management tool in-house. Most health plans rely on vendors with NCQA-certified health risk assessments and self-management tools rather than go through the expense of developing their own. When health plans delegate to vendors that have already passed NCQA’s thorough review, they receive oversite relief for all the standards that apply:
- HRA certification is the equivalent of PHM 4, elements A-G
- Self-management tool certification is the equivalent of PHM 4, elements F-K
NCQA certification is a testament to a company’s commitment to participant experience and scientific validity. The certification process requires a substantial amount of time and resources, such as usability testing, documentation, and product review and enhancement. Companies that don’t want to go through the rigorous process themselves—such as wellness service providers, employers, and government agencies—use NCQA-certified HRAs and self-management tools because they know they provide quality data and a quality experience for the individuals who take them.
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