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Choosing a group health plan: accreditation organizations
When it comes to health plan accreditation, employers tend to look for the seal of approval from one of three organizations: the National Committee for Quality Assurance (NCQA), URAC and The Joint Commission.
Of these three, the most well-known is the NCQA, which began accrediting managed care organizations — especially HMOs and POS plans — in 1991. The NCQA's Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used by more than 90 percent of health plans to measure performance in care and service.
NCQA has valuable online tools for health care consumers. The Health Plan Report Card strives to answer your most pressing questions, such as: Does this health plan provide good customer service? Will I have access to care I need? If I get sick, which plan will take better care of me?
URAC (formerly known as the Utilization Review Accreditation Commission has accreditation standards for just about everything, from health plan standards for an entire organization down to the quality of one single area, such as case management.
The Joint Commission (formerly named the Joint Commission on Accreditation of Healthcare Organizations) focuses on improving the quality and safety of care provided within hospitals, nursing homes and rehabilitation centers. To earn and keep The Joint Commission's Gold Seal of Approval, an organization must have an on-site survey by a Joint Commission survey team at least every three years (labs every two years).
In addition, The Joint Commission provides a comprehensive guide to the nearly 15,000 Joint Commission-accredited health care organizations and programs, plus organizations that are not accredited. At QualityCheck.org, you'll find each accredited organization's most recent "Quality Report."