Ncqa Report Cards (2024)

FAQs

How important is NCQA accreditation? ›

For employers—whether they are self-insured or fully insured—NCQA Accreditation means that an independent, nationally recognized organization has validated a plan's performance. Without NCQA Accreditation, there is no assurance for employers that a health plan is truly committed to meeting quality standards.

NCQA ratings are based on three types of quality measures: measures of clinical quality from NCQA's Healthcare Effectiveness Data and Information Set (HEDIS®2); measures of consumer satisfaction using Consumer Assessment of Healthcare Providers and Systems (CAHPS®3); and results from NCQA's review of a health plan's ...

NCQA's State of Health Care Quality Report

The State of Health Care Quality Report provides summarized performance data from the previous calendar year for key HEDIS^® and CAHPS^® measures. The report documents performance trend over time and tracks variation in care.

The typical evaluation time frame is 12 months from application submission to decision, depending on an organization's readiness. Some organizations may already be working within NCQA guidelines.

The state legislature made it official when it passed AB 133. The new law designates NCQA as the required and sole accreditor of California's commercial plans. That means three of the four California public sector agencies officially require NCQA Health Plan Accreditation (HPA) for the plans they regulate.

1 HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

All health plans that submit HEDIS data to NCQA must be audited every year—that means hundreds of HEDIS compliance audits.

NCQA standards are a roadmap for improvement—organizations use them to perform a gap analysis and align improvement activities with areas that are most important to states and employers, such as network adequacy and consumer protection. Standards evaluate plans on: Quality Management and Improvement.

The Report Cards show the quality of health care for millions of Californians who get their care through medical groups and commercial insurance plans. Quality health care is getting the right care at the right time.

What is the NCQA known for? ›

NCQA Health Plan Accreditation is a widely recognized, evidence-based program dedicated to quality improvement and measurement. It provides a comprehensive framework for organizations to align and improve operations in areas that are most important to states, employers and consumers.

Some HEDIS and CMS Star Ratings measures are based on measures across six domains of care including effectiveness of care and utilization. One of the ways to improve your scores is through increased outreach and better follow-up patient care.

With an accredited institution, a student has some assurance of receiving a quality education and gaining recognition by other colleges and by employers of the course credits and degrees earned.

Accreditation is used to measure the quality of healthcare organizations. Going through the accreditation process will help your organization highlight strengths, reaffirm your commitment to compliance, and drive continuous improvement.

Using NCQA Health Plan Accreditation (HPA) to Ensure Quality

Twenty-seven states require that health plans serving their Medicaid population be accredited by NCQA – with seven others accepting our HPA as meeting broad accreditation requirements.

Accreditation is important because it:

Helps determine if an institution meets or exceeds minimum standards of quality. Helps students determine acceptable institutions for enrollment.