Accreditation programs
A regulatory body or accrediting body is typically a voluntary program whereby trained external peer reviewers usually evaluate the compliance of a healthcare organization and comparing it with the pre-established standards of performance. The general accreditation programs are typically perceived to improve the process and structure of care build on a good body of evidence that shows accreditation programs enhancing clinical outcomes. Therefore, the most appropriate study evaluated is the Quality Assurance Program (QAP) trial. Besides, in healthcare, the accrediting agencies include the Joint Commission on Accreditation of Healthcare Organization (JCAHO), the National Committee for Quality Assurance (NCQA), the American Medical Accreditation Program (AMAP), and the American Accreditation Healthcare Commission (AAHC), among others. The main aim of this paper is to evaluate the impacts of the National Committee for Quality Assurance (NCQA) on the quality of healthcare services.
The history of the National Committee for Quality Assurance (NCQA)
The NCQA was started in 1979 by large employers who were purchasing health maintenance organization services, managed care providers, and the Group Health Association of America. The act of large employers thwarted the establishment of a federal system of regulation set to evaluate managed care organizations. The charges based on underutilization of services as a result of cost constraints in managed care companies propelled the establishment of an independent body to evaluate different plans. The NCQA became independent in 1990 and was aided by a grant from the foundation of Robert Wood Johnson. In 1991, the NCQA began accrediting managed care companies and as well as physician companies. In November 1993, the first performance-based on measurement set, information set, and Plan Employer Data was released. Subsequently, in 1995, the NCQA issued out a technical update, HEDIS 2.5, and was followed with Medicaid HEDIS, including specific measures to the population of Medicaid. In 1996, HEDIS 3.0 was released.
HEDIS has developed performance measures based on healthcare plans. About 89% of all health plans usually measure their performance based on the protocols that are defined by HEDIS on various factors of care and services like the rate of immunization, rates of mammography, and member satisfaction. Beside, HEDIS was created in an attempt to standardize how health plans help in calculating and reporting data concerning their performance. The performance measures of HEDIS 3.0 fall into eight main areas, including access and availability of care, the stability of health plan, the effectiveness of care, satisfaction based on the experience of care, cost of services, healthcare choices, service use, descriptive measures of health plan, and cost of care. Besides, HEDIS Compliance Audit was started to address the variability in the manner health plan obtains and calculate HEDIS data and the approaches employed by the auditors in verifying such data.
The main reason for the existence of NCQA is to improve the quality of healthcare through the administration of evidence-based standards, programs, accreditation, and measures. The reports of NCQA include health plan ratings, state of quality of health care, and quality compass. Public reporting on the NCQA metric plays an essential role since an immediate improvement in patient care. Conversely, the increase in the number of parameters leads to the consumption of more resources, whereas fewer resources are being focused on the continuous improvement process. The NCQA is considered as a central figure in driving healthcare system improvement, thereby helps in elevating issues of quality healthcare to the top national agenda. The mission of NCQA is the provision of information, enabling purchasers and consumers of managed healthcare to distinguish plans based on quality, thus allowing them to make more informed decisions on healthcare purchasing. Various employers use the NCQA as a tool of pressurizing health plans to raise their quality standards.
Ultimately, the main impact of the NCQA on healthcare organizations is strengthening the organization and providing high-quality healthcare. Therefore, the achievements and maintenance of accreditation provide benchmarks set for measuring how different healthcare organizations are carrying out their operations. Besides, the NCQA carries out voluntary certification for managed care plans. Therefore, the accreditation process of NCQA is characterized by a rigorous survey in determining whether the managed care organization meets the set standards in the primary areas like administrative and clinical systems based on the health plan. Performance and standard measures are categorized into various categories, such as access and service, staying healthy, qualified providers, living with illness, and getting better.
In terms of nursing practice, various studies have indicated that NCQA improves the overall quality of care in the multiple facilities of healthcare. In nursing specialty, NCQA programs have aid in improving patient outcomes, thus improving the quality of healthcare by lessening variations in the manner different members of the staff and departments care for their patients. The NCQA recognizes managed care plans and expecting the organizations of the managed care to contract accredited health centers and hospitals. Therefore, the NCQA strongly supports the ideas of the healthcare providers undergoing other reviews instead of relying only on internal assessment. Also, NCQA certifies the verification of various credentials or various organizations, hence evaluating the process that is involved in credentialing operations of organizations and the multiple methods of improving services.