Quality healthcare can be defined as the extent to which patients get the care they need in a manner that most effectively protects or restores their health. This means having timely access to care, getting treatment that medical evidence has found to be effective and getting appropriate preventive care. Choosing a high quality health plan, and a high quality doctor, plays a significant role in determining whether members get high quality care. The National Committee for Quality Assurance (NCQA) develops standards and performance measures in conjunction with health plans, employers, providers, industry leaders, policy makers, heath care analysts and pharmaceutical companies to assess a plan’s performance in these in these dimensions.
The Department of Health and Human Services (HHS) has designated NCQA as an accrediting entity for Qualified Health Plan (QHP) issuers participating in Health Insurance Exchanges.
Health Plan Accreditation - Excellent
Health Plan Accreditation (HPA) is built on twenty years of experience, comprehensive research and dedication to quality to improve the health and experience of members. In addition, HPA contains all of the key elements the law requires for QHP participation. Excellus BlueCross BlueShield has obtained an ‘Excellent’ level of accreditation. This means that service and clinical quality components meet or exceed the rigorous NCQA requirements for consumer protection, quality improvement, provider access/availability, utilization management, credentialing, satisfaction and credentialing. HEDIS/CAHPS results are in the highest range of national performance.
Medicare Advantage Deeming - Deemed Status
The Centers for Medicare & Medicaid Services (CMS) has granted NCQA deeming authority for the Medicare Advantage (MA) program. This authority allows NCQA to review MA organizations on behalf of CMS in six key categories: access to services; antidiscrimination, confidentiality and accuracy of enrollee records; information on advance directives; provider participation rules; and quality improvement. MA organizations that meet NCQA standards for these categories are compliant with corresponding CMS requirements.