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Introduction to Health Services Research : A Self-Study Course
Module 3: Selected Players (Federal and Private) (Page 22 of 27)
National Committee for Quality Assurance (NCQA)
NCQA (http://www.ncqa.org/) is an independent, nonprofit organization founded in 1979 whose mission is to make health plans accountable for the quality of their care and services.
NCQA evaluates health plans through accreditation reviews and develops instruments to measure health plan performance. Its 50 accreditation criteria are specific, demanding, and objective. They include criteria for quality improvement, utilization management, physician credentialing, members' rights and responsibilities, preventive health services, and medical records/peer reviews.
HEDIS
NCQA developed HEDIS, the Health Plan Employer Data and Information Set, that enables managed care plans to standardize how they specify, calculate, and report performance data.
Since all plans are able to report data in a uniform way, NCQA can produce an audited report card to give purchasers and consumers the ability to compare health plans on the basis of quality as well as price.
Notification Services
Check the NCQA Quality Matters webpage for information on NCQA's notification/newsletter service.
Discussion Questions
- What is the difference between NCQA and JCAHO? Do you need to know the difference?
- Examine NCQA's site map. The site has many different types of information available. Which information would be of most interest to researchers? To librarians? To the public?
- One of NCQA's publications deals with disease management standards and guidelines. What is the relationship between disease management and NCQA's mission?
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