What Does NCQA Accreditation Mean and Why Is It Important?
Discover what the NCQA does, types of recognition, and the 4 benefits of NCQA accreditation
If you’re operating a virtual care company, it’s not just about providing accessible care; it’s about delivering high-quality care. In a growing market, where telehealth organizations are springing up rapidly to meet increasing patient demands, it's quality that’ll set businesses apart.
However, how do you show that your company is committed to offering superior care and should be a trusted option? One way to achieve this is to obtain NCQA accreditation and/or partner with a company that’s been accredited. Therefore, below, we’re going to explore what NCQA is, the top NCQA accreditation benefits, and more.
What is NCQA?
The National Committee for Quality Assurance, or NCQA, is a nonprofit organization dedicated to improving healthcare quality. They’re regarded as the industry standard and the top healthcare accreditation organization for physicians, insurers, and other healthcare practices.
Founded in 1990, they create performance measures, such as the Healthcare Effectiveness Data and Information Set (HEDIS), and establish evidence-based standards against which companies can measure their performance. The combination of data, research, and benchmarks helps drive objective decision-making that can lead to more optimal care outcomes.
What does the NCQA do?
NCQA has accreditation, certification, and recognition programs that highlight top healthcare organizations that prioritize improvement initiatives.
Some examples of their programs are:
Medical Staff Credentialing Accreditation
Health Information Product Certification
Virtual Care Accreditation
Patient-Centered Medical Home Recognition
Credentials Verification Organization (CVO) Certification
Companies that meet the requirements of a particular program can display the NCQA program seal of approval on their website and marketing materials.
In addition to the above, the non-profit collaborates with organizations in both the government and private sectors by helping them measure data more effectively and boost quality.
The difference between NCQA accreditation, certification and recognition
To preface, regardless of the program a company completes, each designation demonstrates its commitment to quality and improved patient outcomes. However, the scope of review differs.
What does NCQA accreditation mean?
If an organization achieves NCQA accreditation, it means that it has undergone a rigorous and comprehensive evaluation of its standards and processes. Accreditation demonstrates to others that an organization has met NCQA’s standards for quality, safety, and patient care.
From the viewpoint of patients and regulatory agencies, it reveals that an organization is committed to quality. After all, no one is required to seek accreditation. It’s entirely optional to take part in this. Therefore, when companies in the healthcare space do follow through with it, knowing it’ll likely require a significant portion of their resources, it’s viewed very positively.
OpenLoop holds the Credentialing Accreditation which evaluates the operations of organizations providing full-scope credentialing services, which includes verifying practitioner credentials and credentialing/recredentialing committee review of practitioners.
What does it mean to be NCQA-Certified?
With accreditation, NCQA evaluates an organization's full scope of operations and performance. Gaining NCQA certification, on the other hand, often pertains to more specific functions and focuses on certain services.
For instance, OpenLoop holds the Credential Verification Organization (CVO) certification, demonstrating our adherence to standards for credentialing and verifying provider information. This process, too, can take approximately one year to complete and has stringent eligibility requirements.
Understanding NCQA recognition programs
Achieving NCQA Recognition showcases that an organization has implemented best practices in a particular model of care. The Patient-Centered Medical Home (PCMH) Recognition program, for example, requires companies to review NCQAs concepts and make changes that align with them. If they earn the designation, businesses must still implement quality improvement initiatives and report them to NCQA annually to maintain PCMH recognition.
What does the NCQA Accreditation process look like?
To gain a better understanding of what it entails, it’s best to look at an example.
So, let’s say an organization wants to become NCQA-accredited in credentialing and recredentialing, like OpenLoop has. Typically, the entire process, from applying to receiving a decision, takes at least 12 months and involves the following:
Purchasing and carefully reviewing NCQA’s Standards and Guidelines document
Using NCQA’s Survey Tool to perform a gap analysis. This process usually begins 9 to 11 months prior to the desired survey start date, allowing your company to identify areas where changes are necessary. From there, you're expected to create a project plan and begin implementing improvements.
Some standards require a 6-month look-back period, where you have to meet the standards for at least 6 months before the survey date.
Submitting the Survey Tool 3 months before the survey date. In some cases, NCQA also schedules an on-site file review about 7 weeks after the survey submission.
Receiving a preliminary report that must be reviewed and requirements fulfilled within two weeks.
Being evaluated by a Review Oversight Committee
And more
As you can see, this process is tedious, but achieving accreditation, or partnering with a company that has, does come with benefits that we’ll explore more next.
4 benefits of partnering with or being NCQA-Accredited
It’s no secret that the telehealth market is experiencing rapid growth, spelling out a lot of competition among virtual care delivery practices. To provide some perspective, the global telehealth market size was estimated at $123.26 billion in 2024 and is expected to reach $455.27 billion by 2030.
So, what can your virtual care company do to differentiate itself? The short answer is to obtain or partner with an NCQA-accredited organization.
Now, let’s explore how NCQA accreditation benefits your company.
1. Maintain telehealth compliance
Since 2020, NCQA has worked to incorporate telehealth with various other care modalities to enhance patient-provider relationships and improve quality. This has led to the update of 40 HEDIS measures and several program adjustments. They’ve recognized the role telehealth has played in making care more accessible and aim to align their measures with the guidelines shared by federal and state regulators.
With this in mind, if your company partners with an NCQA-accredited organization, you’ll benefit from this adherence to quality.
2. Improve the patient experience
Much of what NCQA does is designed to enhance the patient experience, minimize risk to patients by ensuring the clinicians providing care to them meet quality and compliance standards, and improve satisfaction. This is evident in the standards and guidelines they’ve created, which prioritize patient preferences, care outcomes, accessibility, and other key factors. As a result, companies that partner with an NCQA-accredited telehealth organization may notice more positive patient feedback and increased patient-provider loyalty.
3. Enhanced operational efficiency
Whether it be credentialing processes or data integration, the NCQA framework revolves around efficient care. Organizations displaying the NCQA seal of approval are expected to eliminate waste and redundancies and focus more on data-driven, high-value actions.
So, what might this look like for your virtual care delivery business? If you obtain or partner with an NCQA-certified CVO, you’d benefit from streamlined administrative processes, automated workflows, and carefully designed policies and procedures. Each of these can lead to significant cost savings and greater productivity. Plus, you can free up your internal team so they can prioritize other pressing tasks.
4. Stronger payer relationships
When you obtain or collaborate with an NCQA-certified CVO, you can count on having a high-quality network of practitioners. The seal of approval demonstrates their ability to deliver efficient verification services that meet state requirements and align with the expectations of health plans.
Maintain telehealth compliance with OpenLoop Health
Telehealth compliance guidelines are constantly evolving, and such rapid changes in regulation can lead to concerns about patient safety and quality of care. However, by following the clear standards and guidelines provided by NCQA, delivering excellent virtual care is still possible.
One way you can showcase your business's unwavering commitment to prioritizing high-quality virtual care is by delegating to an NCQA-accredited company, like OpenLoop Health. Our robust telehealth infrastructure and streamlined medical credentialing process will ensure you provide scalable, flexible, and accessible telehealth solutions.
Want to learn more? Contact us today!
Our full suite of white-labeled virtual care services includes: