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Four reasons why you should not pursue NCQA accreditation

DeltaSigma, LLC Consulting | Four reasons why you should not pursue NCQA accreditation

Many organizations that are not currently accredited do aspire to obtain some type of accreditation, whether health plans, ACOs, physician organizations, or hospitals, among many others. The reasons are varied: demonstration to purchasers that they have passed quality standards, desire to have health plans delegate to them, or meeting regulatory requirements for some form of accreditation. The typical options are URAC and NCQA. However, there are some reasons why you should avoid NCQA accreditation.

  1. Part of your leadership team believes that accreditation is unnecessary. Accreditation is hard work. The Quality Department, and sometimes Compliance, are responsible for accreditation activities. If the executives responsible for those departments are not totally invested in the process and do not think that it provides great value, it will be an uphill battle. It may even end in failure. It is not for the faint hearted.

  2. Your customers do not require accreditation. The NCQA accreditation process is costly, and for health plans, the application and survey process is only one component of that process. Eventually plans have to report HEDIS and CAHPS to NCQA. These requirements also entail a great deal of cost, including choosing a certified vendor, fielding surveys and chasing patient charts to abstract data for the HEDIS measures. That’s not all – the percentile in which the organization attains the results are the determinants of the final accreditation level because these measures are 50 points of the total accreditation score! Organizations must use quality improvement processes to improve results for a higher score. Why would anyone do this when it is not required?

  3. You want to take the easy way out if accreditation is required. Certainly, as an NCQA surveyor, I am biased in that I think NCQA is more difficult to attain, especially since I used to help organizations obtain URAC accreditation. But when I ask people in a URAC-accredited organization why they chose URAC instead of NCQA, over and over and over again they indicate that URAC is much easier. Even though NCQA is the gold standard (their words), when faced with attaining accreditation, they frequently choose URAC. An exception is that the Affordable Care Act required accreditation within a certain time period to be able to sell on the federal exchange. During implementation of these new marketplaces, 85% of the plans chose to seek NCQA accreditation. The main reason was that the NCQA had developed a glide path to help organizations which were not previously accredited. This Interim Accreditation provided the organization time to put processes in place to be able to go through First Accreditation 18 months after Interim. The plans indicated that they might as well pursue the highest value accreditation when required to have accreditation for Marketplace products.

  4. You want one Department to do all the work. When knowledge is not shared with the other departments about the requirements of the standards, departments will remain siloed and not work optimally. Training staff takes time and resources, whether time invested in developing training slides, leading work groups, retaining a consultant, or auditing processes and files. It leads to an appearance of “smoke and mirrors,” and surveyors can typically see through this veneer. Investing in training people will cause them to be more valuable to other organizations. There is this famous interchange: Question: “What if we train people and they leave? Response: “What if we don’t train them and they stay?” The standards make good business sense when woven into the fabric of the organization.

I have had the privilege of working with many organizations new to the accreditation process. Those who “get it” have expressed how it makes their organization function more smoothly and become less siloed because the accreditation process forced them to communicate. It has promoted conversations across departments internally and externally with those who partner with them.

And it fosters a culture of continuous quality improvement. If you do not want change, then you should avoid NCQA accreditation.

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