NCQA: A Nonprofit Leader in U.S. Healthcare Quality Assurance
What is NCQA?
NCQA (National Committee for Quality Assurance) is a private, non-profit organization dedicated to improving healthcare quality. Since its establishment in 1990, NCQA has been a central force in advancing the U.S. healthcare system and has prompted the government to prioritize healthcare quality on the national agenda.
The NCQA Board of Directors includes representatives from employers, employees, consumers, health plans, quality experts, policymakers, and medical organizations. By collaborating with employers, policymakers, physicians, and patients, NCQA helps stakeholders reach consensus on the importance of healthcare quality, its measurement, and strategies for improvement.
The NCQA Seal is a recognized symbol of quality. Organizations must undergo rigorous, comprehensive reviews to include the Seal in their advertising or marketing materials, and they are required to submit annual reports to the NCQA. For consumers and employers, the Seal serves as a reliable indicator of an organization’s ability to deliver high-quality healthcare services.
The Role of NCQA
NCQA’s programs and services reflect a simple formula: Measure, Analyze, Improve, Repeat. By enhancing quality standards and performance measurement for healthcare organizations, NCQA has facilitated the widespread adoption of this approach across the healthcare sector. Furthermore, through media and consumer feedback on these measures published in annual reports, organizations and individuals can leverage these results to refine their agendas for the following year.
NCQA’s contribution to the national healthcare system is regularly measured by statistical data tracking the quality of care in national health plans. In each of the past five years, these metrics have improved: healthcare protocols have been enhanced, physicians have acquired knowledge of additional treatment modalities, and patients have become more engaged in their own care. These improvements have gradually translated into more lives saved, better disease prevention, and lower treatment costs. For example, among heart disease patients treated with beta-blockers, the risk of recurrent events can be reduced by up to 40%.
NCQA Standards
NCQA has been continuously raising its standards. Today, a health plan must comply with more than 60 stringent requirements and submit care reports from over 40 regions to achieve accreditation. Teladoc is the first and only telemedicine provider in the United States to hold NCQA accreditation, a standard that undergoes reevaluation every three years.
The most recent review was conducted on June 26, 2015, when Teladoc once again achieved a perfect score of 100 to renew its NCQA accreditation. This marks the second time that Teladoc has earned full marks from the review experts, following its initial NCQA accreditation on June 5, 2013. Henry DePhillips, M.D., Chief Medical Officer of Teladoc, stated, “Our ongoing commitment to meeting NCQA standards demonstrates our company’s relentless pursuit of clinical excellence. It confirms that Teladoc has the capability to meet the most rigorous requirements and quality standards, ensuring the delivery of high-quality healthcare services to our members.”
Health plans in every state, the District of Columbia, and Puerto Rico have received NCQA accreditation. These plans cover 109 million Americans, meaning that 70.5% of the total U.S. population is enrolled in these health plans.
Introduction to the NCQA Recognition Program
Ten years ago, NCQA launched its first recognition program. Today, NCQA programs have identified thousands of high-quality clinicians. Federal, state, and local governments, insurance companies, self-insured employers, and medical conferences all seek various types of clinicians through the NCQA recognition programs.
NCQA's Clinical Recognition programs were developed in collaboration with national expert panels for diabetes, ischemic heart disease, and cerebrovascular disease. They primarily include four categories:
1. Diabetes Physician Recognition Program (DPRP);
2. Heart/Stroke Recognition Program (HSRP);
3. Physician Practice Connections (PPC);
4. Patient-Centered Medical Home (PCMH)
It also offers products to certify whether a healthcare organization’s care delivery system is qualified and patient-centered. NCQA’s Patient-Centered Medical Home (PCMH) recognition program for primary care physicians was launched in 2008. The 2011 version built upon the 2008 edition’s emphasis on health information technology and care management by placing greater focus on team-based care, cultural sensitivity, and patient experience, while the new requirements introduced in 2014 continued this trajectory.
By Liu Nan | Edited by Mo Renying
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