NCQA: What does it mean for Payers?
February 15, 2012 by Ani Young
As healthcare reform moves onward, National Committee for Quality Assurance (NCQA) accreditation is garnering more celebrity by all players within the healthcare space.
Some payers and providers fear it; consumers praise it; and at Healthx we aim to help all of our clients attain it.
But what does NCQA accreditation mean, exactly? Most consumers who are thrown by the ins and outs of the healthcare industry have no idea. But the National Committee for Quality Assurance (NCQA) is considered the most stringent and influential health plan accreditation programs in the industry, and helps ensure that the physicians and insurers you enlist are up to par.
Unfortunately not all health plans make the cut. But many big-time employers refuse to do business with plans that don’t earn NCQA’s stamp of approval. Yea - it’s that important.
Most of our current clients rely on Healthx technology to help them meet many of NCQA’s elite standards. Below are the specific accreditation standards we help our clients achieve:
Health Appraisals – Plans need to help members evaluate their health and overall life risks, and develop ways to reduce these risks.
Self-Management Tools – Insurers must provide clear self-management tools accessible by phone, print, and online portals that address issues like healthy weight maintenance, smoking cessation programs, exercise and diet guidance, stress management, alcohol/drug avoidance, symptoms of depression, etc.
Functionality of Claims Processing – The Plan must offer members both telephone and online service with access to Claims information.
Personalized Information on Health Plan Services – A Health Plan’s healthcare portal must offer members the functionality to request or reorder their ID card or change primary care physicians.
Innovations in Member Services – Insurers should be seen as advocates of healthcare IT use that improves the overall healthcare experience for members. This is determined by how progressive an organization proves itself in the health insurance technology field.
Encouraging Wellness and Prevention – Plans need to deliver wellness follow-ups to members based on their specific member information.
Ultimately, providing easier access to providers on critical medical and insurance information makes for a better quality assurance standard. Our payer technology solutions are based on helping organizations achieve this necessary accreditation on multiple levels. Healthx portals are a place where consumers can access critical healthcare information like Benefits, Eligibility, Claims statuses, etc.
Our offering includes many more applications for increased engagement, including a robust Wellness program that encompasses all of the NCQA requirements you see above. The Wellness Program aligns with the core concept of reform: creating a healthier country. Need to lose weight? We have a program for that. Trying to stay on track with your diabetes care? There’s a program for that. And the list goes on and on.
NCQA is important to payers and members alike, therefore it’s important to us. We continue to develop our technology around these quality standards.
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