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NUR 621 What is the difference between the National Committee for Quality Assurance (NCQA) and the Utilization Review Accreditation Commission (URAC)?

NUR 621 What is the difference between the National Committee for Quality Assurance (NCQA) and the Utilization Review Accreditation Commission (URAC)?

NUR 621 What is the difference between the National Committee for Quality Assurance (NCQA) and the Utilization Review Accreditation Commission (URAC)?

KNOWLEDGE CHECK

What is the role of accreditation on quality? Provide one example to support your discussion.

REPLY

I think accreditation helps to improve the quality of services provided in the healthcare sector. Research has showed that healthcare facilities that are accredited provide a higher quality of care than those that are not accredited, which result in better patient outcomes. If a healthcare institution is not accredited, it does not have to maintain any standards of healthcare, because it does not have to any accrediting agency to critique its policy or procedures to a certain standard. As the saying goes” if there is no accountability there is no responsibility”.

Reference:

Akmal, A., Podgorodnichenko, N., Foote, J., Greatbanks, R., Stokes, T., & Gauld, R. (2021). Why is Quality Improvement so Challenging? A Viable Systems Model Perspective to Understand the Frustrations of Healthcare Quality Improvement Managers. Health Policy, 125(5), 658–664. https://doi.org/10.1016/j.healthpol.2021.03.015

REPLY

Accountable Care Organization (ACO) consists of networks of providers that are rewarded financially if they can slow the growth in their patients’ healthcare spending while maintaining or improving the quality of care they deliver. For ACOs to be a success, there must be a collaboration of care. The goal of the ACOs is to provide well-coordinated, cost-effective care when clients need it. Under the Shared Savings Program, ACOs must meet several eligibility requirements, including providing certification to the Centers for Medicare and Medicaid Services (CMS) and their ACO application to be considered for and participate in this saving program (Strategic Management Services, 2022).

The National Committee for Quality Assurance (NCQA) is a private non-profit organization dedicated to improving healthcare quality (NCQA, 2022). The NCQA’s mission is to improve health care quality with the vision of better healthcare, better choices, and better

NUR 621 What is the difference between the National Committee for Quality Assurance (NCQA) and the Utilization Review Accreditation Commission (URAC)
NUR 621 What is the difference between the National Committee for Quality Assurance (NCQA) and the Utilization Review Accreditation Commission (URAC)

health (NCQA, 2022). The NCQA developed quality standards and performance measures for a broad range of healthcare entities, and these tools helped organizations and individuals to identify opportunities for improvement (NCQA, 2022). The NCQA Health Plan Accreditation help to meet the goal of a plan that supports care that keeps members at an optimum level of health while controlling costs and meeting government and purchaser requirements (NCQA, 2021). Another accrediting body that helps to improve the quality of care is the Utilization Review Accreditation Commission (URAC). The URAC is one of America’s most prestigious accrediting organizations and non-profit accreditation entities that helps to improve the quality of care (URAC, 2022). The URAC’s renowned accreditation and certification programs set the highest standards in quality and safety (URAC, 2022).

 

Accreditation is essential in healthcare for accountability and to meet standards. Accreditation helps to improve healthcare quality and adherence (URAC, 2022). Health plans may choose one accrediting organization over another because of costs, accreditation process, recognition, and the different requirements needed to be accredited. Despite the choice of the accrediting body, the aim is to ensure high-quality care.

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References

 

National Committee for Quality Assurance. (2021). Health plan accreditation. https://www.ncqa.org/programs/healthplans/health-plan-accreditation-hpa/

 

National Committee for Quality Assurance. (2022). About the NCQAhttps://www.ncqa.org/about-ncqa/

 

Strategic Management Services. (2022). Accountable care organizations: ACO final rule summary.

https://www.compliance.com/resources/accountable-care-organizations-regulations-aco-final-rule-summary/#aco-regulations

 

Utilization Review Accreditation Commission. (2022). About the URAC. https://www.urac.org/about/

REPLY

Accreditation agencies are impartial organizations that oversee and evaluate the functioning of healthcare organizations to ensure they meet the pre-established performance standards. The accreditation agencies set quality standards and benchmarks to strengthen the organizations’ goals to deliver high-quality patient care. In addition, they oversee the functioning of organizations and physicians to evaluate their performance against the pre-established quality standards. With the paradigm shift from treatment and cure to prevention, health care organizations focus more on continuous quality improvement to promote positive patient outcomes. National Committee for Quality Assurance (NCQA) plays an accreditation role to organizations that incorporate medical groups, physician networks, and health plans such as PPOs and HMOs (Richter & Beauvais, 2018). It utilizes accountability, measurements, and transparency to identify the top healthcare performers and compel improvement. The private sector and the government clients seek the services of NCQA through grants and contracts to measure quality and provide the necessary improvements. NCQA focuses on HEDIS (Healthcare Effectiveness Data and Information Set) in addition to recognition and certification programs.

References

Richter, J. P., & Beauvais, B. (2018). Quality indicators associated with the level of NCQA accreditation. American Journal of Medical Quality33(1), 43–49. https://doi.org/10.1177/1062860617702963.

Denver, R. C. (2011). Accreditation to approve health plans and providers. National Conference of State Legislatures. https://www.ncsl.org/documents/health/HRHealthPlans.pdf.

Payne, J. (2018). A commitment to quality care: URAC accreditation for CA SB1160 and beyond. Mitchell. https://www.mitchell.com/insights/workers-comp/articles/commitment-quality-care-urac-accreditation-ca-sb1160-and-beyond.

REPLY

NCQA (National Committee for Quality Assurance) uses measurement, transparency, and accountability to highlight top performers and drive improvement. It began early in 1990 by measuring and then accrediting health plans. NCQA’s mission has grown to measure the quality of medical providers and practices. Most NCQA employees work on (Healthcare Effectiveness Data and Information Set) HEDIS and accreditation, certification, and recognition programs. Government and private sector clients hire it through contracts and grants to help measure and improve quality. Accreditation is awarded for three years, and certification is awarded for two years. NCQA accredits organizations ranging from health plans including HMOs and PPOs to physician networks and medical groups (National Committee for Quality Assurance, 2022). The (National Committee for Quality Assurance) NCQA requires MCOs (Managed Care Organizations) to report quality indicators and to address concerns about under-care as part of their accreditation requirements. The NCQA uses the (Healthcare Effectiveness Data and Information Set) HEDIS for quality reporting by HMOs and other health plans. Despite the expansion of MCOs in early 1990, increased resistance to managed care by physicians limited the negotiation of HMO contracts in many communities. Consumers and some employers also became resistant to taking part in managed care plans (Penner, 2016).

URAC (Utilization Review Accreditation Commission) is an independent, nonprofit accreditation agency based in Washington, D.C. whose mission is to advance healthcare quality through leadership, accreditation, measurement, and innovation. URAC was founded in 1990 as a third-party healthcare quality validator. URAC uses evidence-based measures and develops standards through inclusive engagement with a broad range of stakeholders committed to improving healthcare quality. Most accreditations are awarded for three years. However, there are two programs with a two-year cycle (Health Content Provider and Health Website). URAC accredits health plan programs including dental plans, healthcare management programs, pharmacy quality management programs, and provider integration and coordination programs (Utilization Review Accreditation Commission, 2022).