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Health plan accreditation: NCQA, JCAHO, or both?

D P Scanlon¹, T J Hendrix

¹Pennsylvania State University, University Park, USA.

Managed Care Quarterly

|March 3, 1999

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Competition between managed care organization (MCO) accreditors like the National Committee for Quality Assurance (NCQA) and the Joint Commission may impact healthcare quality. Purchaser feedback suggests a need to evaluate the benefits and drawbacks of this competitive accreditation landscape.

Area of Science:

Health Services Research
Healthcare Management
Quality Improvement in Healthcare

Background:

Managed care organizations (MCOs) are accredited by the National Committee for Quality Assurance (NCQA) and the Joint Commission.
The existence of multiple accrediting bodies raises questions about the impact of competition on accreditation quality and value.
Understanding purchaser perspectives is crucial for evaluating the effectiveness of healthcare accreditation processes.

Purpose of the Study:

To explore purchaser views on the advantages and disadvantages of competing accreditation processes for managed care organizations (MCOs).
To assess the perceived value of MCO accreditation and the utilization of plan performance measures.
To inform stakeholders about the implications of market competition in healthcare accreditation.

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Main Methods:

Two surveys were administered to purchasers and representatives from health plans and public health organizations.
Participants had attended the Lovelace Health System (LHS) "Accreditation Experience" program, designed to educate on NCQA and Joint Commission processes.
Data collected focused on opinions regarding accreditation processes, value, and performance measures.

Main Results:

Purchaser feedback was gathered on the perceived benefits and drawbacks of both NCQA and Joint Commission accreditation.
The study captured insights into the overall value attributed to MCO accreditation by key stakeholders.
Information was collected on how purchasers use or view the use of plan performance measures in conjunction with accreditation.

Conclusions:

The findings provide insights into the complex dynamics of a competitive market for managed care organization (MCO) accreditation.
Purchaser perspectives are essential for guiding future improvements in healthcare accreditation standards and processes.
Evaluating the impact of accreditation competition is vital for enhancing healthcare quality and accountability.