The NCQA Accreditation Process: Essential Tips
By Jana Altieri RN MS CPHQHealthcare ConsultantManaged Care Consulting ProJune 29, 2023
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With almost 20 years combined experience in healthcare Quality Improvement in both a health plan and as a consultant, I have gained invaluable insights that can significantly contribute to the NCQA accreditation process. By incorporating these suggestions, you can successfully enhance quality outcomes and make notable progress towards achieving NCQA accreditation. While the information provided below offers initial guidance, rest assured that there will be more valuable insights shared in the future.
Quality: A Fundamental Component of Business Processes
Quality is a crucial element that goes beyond a mere periodic accreditation process. By adopting a proactive approach to quality, organizations can achieve ongoing survey readiness. Quality should not be limited to the confines of the Quality Improvement Department within an organization - it should be an integral part of a health plan's DNA, ingrained in every aspect of its operations.
In my observations, it is common to witness many organizations assume that the task of meeting NCQA standards falls solely upon the shoulders of the Quality Improvement Department. However, achieving NCQA accreditation is a collective responsibility that extends beyond a single department. Within a healthcare organization, the responsibility for securing NCQA accreditation should be shared among various stakeholders, including executive leadership, operations teams, clinical staff, and even member services. Each of these groups plays a vital role in meeting the rigorous standards set by NCQA. Executive leadership provides strategic direction and allocates necessary resources, while operations teams ensure efficient processes and workflows. Clinical staff contribute their expertise to deliver high-quality care, and member services ensure a positive experience for members. Creating a culture of continuous quality improvement is vital for organizations seeking to excel in delivering high-quality healthcare services. Here are some strategies to foster this culture throughout your organization:
Embrace NCQA Accreditation as an Organizational GoalMake NCQA accreditation an integral part of your organization's goals and objectives. By including it as a performance goal for staff members, you emphasize the importance of meeting and exceeding accreditation standards. Encourage staff to align their individual goals with NCQA requirements, fostering a sense of ownership and accountability. Recognize and reward employees who consistently surpass these goals, motivating them to strive for excellence.
Provide Organizational NCQA TrainingConsider offering comprehensive NCQA training to staff members at a high level - this could be incorporated into new employee onboarding or part of an annual compliance training. It could provide a broad understanding of the accreditation process, its requirements, and the significance of compliance. By equipping employees with this knowledge, you enhance their understanding of the organization's commitment to quality improvement and the implications of not achieving accreditation. It is essential to communicate the potential repercussions, such as the possibility of losing important business, to emphasize the significance of accreditation.
For the NCQA project leaders within a health plan undergoing NCQA accreditation, I strongly recommend participating in the annual Health Plan Accreditation series. These trainings are conveniently available online, with the upcoming 2024 series scheduled for September to October. The live sessions offer an interactive learning experience, and for added flexibility, the trainings can also be accessed at a self-paced approach after the scheduled dates. It's worth noting that these trainings also provide Continuing Education (CE) credits. For detailed information on NCQA trainings, including the Health Plan Accreditation series, I encourage you to visit the NCQA website at the following link: NCQA Trainings.
In my observations, it is common to witness many organizations assume that the task of meeting NCQA standards falls solely upon the shoulders of the Quality Improvement Department. However, achieving NCQA accreditation is a collective responsibility that extends beyond a single department. Within a healthcare organization, the responsibility for securing NCQA accreditation should be shared among various stakeholders, including executive leadership, operations teams, clinical staff, and even member services. Each of these groups plays a vital role in meeting the rigorous standards set by NCQA. Executive leadership provides strategic direction and allocates necessary resources, while operations teams ensure efficient processes and workflows. Clinical staff contribute their expertise to deliver high-quality care, and member services ensure a positive experience for members. Creating a culture of continuous quality improvement is vital for organizations seeking to excel in delivering high-quality healthcare services. Here are some strategies to foster this culture throughout your organization:
Embrace NCQA Accreditation as an Organizational GoalMake NCQA accreditation an integral part of your organization's goals and objectives. By including it as a performance goal for staff members, you emphasize the importance of meeting and exceeding accreditation standards. Encourage staff to align their individual goals with NCQA requirements, fostering a sense of ownership and accountability. Recognize and reward employees who consistently surpass these goals, motivating them to strive for excellence.
Provide Organizational NCQA TrainingConsider offering comprehensive NCQA training to staff members at a high level - this could be incorporated into new employee onboarding or part of an annual compliance training. It could provide a broad understanding of the accreditation process, its requirements, and the significance of compliance. By equipping employees with this knowledge, you enhance their understanding of the organization's commitment to quality improvement and the implications of not achieving accreditation. It is essential to communicate the potential repercussions, such as the possibility of losing important business, to emphasize the significance of accreditation.
For the NCQA project leaders within a health plan undergoing NCQA accreditation, I strongly recommend participating in the annual Health Plan Accreditation series. These trainings are conveniently available online, with the upcoming 2024 series scheduled for September to October. The live sessions offer an interactive learning experience, and for added flexibility, the trainings can also be accessed at a self-paced approach after the scheduled dates. It's worth noting that these trainings also provide Continuing Education (CE) credits. For detailed information on NCQA trainings, including the Health Plan Accreditation series, I encourage you to visit the NCQA website at the following link: NCQA Trainings.
The Power of Documentation
In healthcare, the adage "If it isn't documented, it wasn't done" holds true when it comes to NCQA accreditation. Accurate and thorough documentation plays a pivotal role in delivering high-quality care. Health care organizations must prioritize comprehensive documentation practices, ensuring that all relevant information is recorded accurately and promptly. Several key areas to pay attention to are provided below:
Committee MeetingsNCQA standards encourage health plans to establish mechanisms for involving practicing providers in various aspects of their operations. This includes involving providers in committees and workgroups responsible for planning, evaluating programs, and making policy decisions. By actively engaging providers in these discussions, health plans can benefit from their firsthand clinical knowledge, experience, and insights, leading to more effective and patient-centered care delivery.
During the survey preparation process, healthcare organizations are obligated to furnish evidence of their collaborations with practicing providers. This evidence often takes the form of committee minutes that reflect the active participation and input of providers in the discussions. Simply demonstrating committee approval is not sufficient; it is essential for the minutes to clearly indicate the extent of collaboration and the active involvement of providers in shaping decisions and contributing to the dialogue. It is essential to diligently document key aspects of meeting discussions, ensuring that the names and/or specialties of the physicians making the statements are cited.
Policies and ProceduresWhen undergoing preparations for an NCQA survey, organizations are obligated to provide evidence across various data sources, including Documented Processes, Reports, Materials, Records, and Files. Among these, Documented Processes stands out as a crucial data source where NCQA seeks a comprehensive write-up detailing how the organization meets the standards in a policy/procedure format that is regularly updated. This documentation essentially serves as a response to the question, "Tell us what you do and how you do it." The Documented Processes section encapsulates the organization's policies, procedures, and protocols, offering a transparent and comprehensive account of their operations and how they align with the NCQA standards. It is a key component that showcases the organization's commitment to quality and adherence to the prescribed guidelines. Additionally, when you spend a long time working at an organization, you become accustomed to its internal processes and may overlook the fact that outsiders might not be familiar with them. To address this, it's crucial to document all the steps involved in a process. This comprehensive documentation ensures clarity and understanding for those who are not part of the organization.
Program and Project EvaluationNCQA places great importance on analytics and data, but when it comes to surveyors, they require the data to be presented in a way that is easily understandable. In many cases, standards involving analysis necessitate both quantitative and qualitative analysis. NCQA has specific definitions for these terms. It's important to note that NCQA recently provided clarification regarding their definitions of qualitative and quantitative analysis. The following are NCQA’s definitions as quoted from the "NCQA Policy Updates - November 14, 2022":
Committee MeetingsNCQA standards encourage health plans to establish mechanisms for involving practicing providers in various aspects of their operations. This includes involving providers in committees and workgroups responsible for planning, evaluating programs, and making policy decisions. By actively engaging providers in these discussions, health plans can benefit from their firsthand clinical knowledge, experience, and insights, leading to more effective and patient-centered care delivery.
During the survey preparation process, healthcare organizations are obligated to furnish evidence of their collaborations with practicing providers. This evidence often takes the form of committee minutes that reflect the active participation and input of providers in the discussions. Simply demonstrating committee approval is not sufficient; it is essential for the minutes to clearly indicate the extent of collaboration and the active involvement of providers in shaping decisions and contributing to the dialogue. It is essential to diligently document key aspects of meeting discussions, ensuring that the names and/or specialties of the physicians making the statements are cited.
Policies and ProceduresWhen undergoing preparations for an NCQA survey, organizations are obligated to provide evidence across various data sources, including Documented Processes, Reports, Materials, Records, and Files. Among these, Documented Processes stands out as a crucial data source where NCQA seeks a comprehensive write-up detailing how the organization meets the standards in a policy/procedure format that is regularly updated. This documentation essentially serves as a response to the question, "Tell us what you do and how you do it." The Documented Processes section encapsulates the organization's policies, procedures, and protocols, offering a transparent and comprehensive account of their operations and how they align with the NCQA standards. It is a key component that showcases the organization's commitment to quality and adherence to the prescribed guidelines. Additionally, when you spend a long time working at an organization, you become accustomed to its internal processes and may overlook the fact that outsiders might not be familiar with them. To address this, it's crucial to document all the steps involved in a process. This comprehensive documentation ensures clarity and understanding for those who are not part of the organization.
Program and Project EvaluationNCQA places great importance on analytics and data, but when it comes to surveyors, they require the data to be presented in a way that is easily understandable. In many cases, standards involving analysis necessitate both quantitative and qualitative analysis. NCQA has specific definitions for these terms. It's important to note that NCQA recently provided clarification regarding their definitions of qualitative and quantitative analysis. The following are NCQA’s definitions as quoted from the "NCQA Policy Updates - November 14, 2022":
Simply providing a table with numerical data, trends, benchmarks and goals is not sufficient for quantitative analysis. It is essential to include narrative language that effectively communicates the story behind the data. Below are some questions to ask when preparing your analysis that will help to meet the intent of NCQA’s definition:
- How did the rate trend change over time?
- Did the rate increase or decrease?
- How does the rate compare to the benchmark and the set goal?
- What significant trends can be identified over time?
- What methodology was used and did it change over your re-measurement periods?
- If surveys were used - how were they administered, to whom, what was the response rate, what were the exact questions asked?
- A few additional tips:
- Keep in mind what your baseline and re-measurement periods are
- Perform analysis specific to each Accreditable Entity for which you are being evaluated for accreditation (e.g. line of business).
- Make sure to tie your barriers and opportunities for improvement back to your specific results.
- Define goals that are specific and measurable. One common method of defining goals is using the acronym SMART. The acronym SMART stands for Specific, Measurable, Achievable, Relevant, and Time-bound:
ConclusionFor health plans, quality should be an ongoing pursuit rather than a sporadic endeavor tied to accreditation renewals. By integrating quality into every aspect of their business processes, ensuring comprehensive documentation and attending NCQA trainings, health plans can elevate their performance and meet or exceed NCQA accreditation standards. Embracing a culture of continuous quality improvement is the key to delivering exceptional care and meeting the evolving needs of healthcare consumers.
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NCQA. (2022, November 14). NCQA Policy Updates - November 14, 2022. Retrieved from https://www.ncqa.org/wp-content/uploads/2022/11/2020-WHP-Policy-Updates_11-14-2022.pdf.
Disclaimer: Jana Altieri, an independent consultant with Managed Care Consulting Pro, provides opinions based on experience and is not affiliated with NCQA. For specific information, please refer to the official NCQA Standards and Guidelines.