How Can Accreditation Programs Promote Health Plan Value?

August 30, 2018 - Health plan accreditation programs can help payers highlight offerings that deliver on key quality, efficiency, and beneficiary satisfaction measures.

Many health plans currently participate in the HEDIS performance set and receive numerical scores based on chronic disease management, customer service quality, and preventive care capabilities.

However, payers can supplement their current performance efforts with specialized accreditation programs that display a health plan’s unique features and expertise for addressing specific healthcare concerns.

A number of accreditation agencies, including the National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC), and the Accreditation Association for Ambulatory Health Care (AAAHC), provide accreditations and certifications to health plans.

NCQA programs help payers demonstrate quality control, wellness, and health inequity

The NCQA offers several health plan certification programs for demonstrating excellence in care quality, wellness, and health equity.

The agency’s Physician and Hospital Quality Certification evaluates how well a health plan measures the quality and costs of its network providers.

The PHQ certification is based on four principles which include measurement standardization, physician transparency, provider collaboration, and quality-to-cost balance. Health plans that receive the PHQ certification demonstrate they can effectively manage quality and cost data to improve the plan’s decision making.  

Employer-sponsored health plans can earn the Wellness and Health Promotion (WHP) certification that evaluates the plan’s ability to use wellness programs to improve employee satisfaction and create healthier workplaces.

Employers can earn the WHP certification if they select high-quality wellness vendors, evaluate the components of an effective wellness plan, and use wellness strategies to reduce employees’ care costs. The certification also places an emphasis on improving employee outcomes through wellness program design.

Employer-sponsored plans may earn up to WHP specializations for excellence in providing health appraisals, self-management wellness tools, and wellness coaching to employees.

NCQA also provides distinction accreditation programs for health plans that address common healthcare issues, including health inequity.

For example, health plans can earn a Multicultural Health Care Distinction from NCQA if the plan uses evidence-based practices to address linguistic and socioeconomic healthcare barriers for members.

“These standards create a roadmap for improving and refining initiatives,” NCQA said. “Participating organizations will be equipped to fulfill state and federal mandates and, in conjunction with performance benchmarks, will be in a position to garner the NCQA seal of distinction, an eminent and premiere symbol of quality in health care.”

URAC provides specialty accreditations for Medicare Advantage and marketplace health plans

URAC provides a general health plan accreditation that evaluates a health plan’s ability to effectively engage beneficiaries, monitor beneficiary populations, administer coordinated care, and develop programs that promote quality care.

URAC also provides specialized accreditations for Medicare Advantage health plans and ACA marketplace health plans.

The URAC Medicare Advantage Accreditation designates s “authority plans” that meet or exceed Medicare standards across six performance categories.  These categories include quality assessment and improvement, beneficiary access to services, provider participation, health plan information about anti-discrimination, and confidentiality and accuracy of enrollee records.

HHS requires qualified health plans (QHPs) offered on the ACA’s health plan exchanges to earn URAC’s Health Insurance Marketplace Accreditation.

The accreditation indicates that a QHP has completed a rigorous review of its operational capabilities, such as quality of care and beneficiary satisfaction.

“Organizations that achieve this accreditation have demonstrated their quality practices and compliance with standards and measures that align with state and federal requirements for value-based healthcare,” URAC explained. “These organizations are subject to additional federal requirements, in addition to all requirements of the Health Plan Accreditation program.”

AAAHC accreditations measure a health plan’s ambulatory care capabilities

AAAHC provides ambulatory care accreditations to employer-sponsored plans, private plans, and QHPs by evaluating eight measurement categories.

The eight main measures are: provider credentialing, case management and care coordination, quality improvement, clinical health records use, patient safety, member protections, and wellness promotion.

AAAHC updated the accreditation process in 2013 to evaluate behavioral healthcare capabilities for ambulatory care settings. In addition, the organization tailors accreditation processes based on the size and operational capability of health plans.

Health plan accreditations are programs that may help payers display excellence in a variety of health plan capabilities and cement themselves as industry leaders. Health plan accreditations help payers assert their claims as the best of the best insurance providers on the market.