Managed Care - INFO
Accreditation Organizations
2007
THE NATIONAL COMMITTEE FOR QUALITY ASSURANCEThe National Committee for Quality Assurance is a private, 501(c)(3) not-for-profit organization dedicated to improving health care quality. Since its founding in 1990, NCQA has been a central figure in driving improvement throughout the health care system, helping to elevate the issue of health care quality to the top of the national agenda.
The NCQA seal is a widely recognized symbol of quality. Organizations incorporating the seal into advertising and marketing materials must first pass a rigorous, comprehensive review and must annually report on their performance. For consumers and employers, the seal is a reliable indicator that an organization is well-managed and delivers high quality care and service.
NCQA has helped to build consensus around important health care quality issues by working with large employers, policymakers, doctors, patients and health plans to decide what’s important, how to measure it, and how to promote improvement. That consensus is invaluable — transforming our health care system requires the collected will and resources of all these constituencies and more.
NCQA’s programs and services reflect a straightforward formula for improvement: Measure. Analyze. Improve. Repeat. NCQA makes this process possible in health care by developing quality standards and performance measures for a broad range of health care entities. These measures and standards are the tools that organizations and individuals can use to identify opportunities for improvement. The annual reporting of performance against such measures has become a focal point for the media, consumers, and health plans, which use these results to set their improvement agendas for the following year.
NCQA’s contribution to the health care system is regularly measured in the form of statistics that track the quality of care delivered by the nation’s health plans. Every year for the past five years, these numbers have improved; health care protocols have been refined, doctors have learned new ways to practice, and patients have become more engaged in their care. Those improvements in quality care translate into lives saved, illnesses avoided and costs reduced. For instance, for every additional person who receives beta blockers after a heart attack, chances of suffering a second, perhaps fatal, heart attack are reduced by up to 40%.
NCQA consistently raises the bar. Accredited health plans today face a rigorous set of more than 60 standards and must report on their performance in more than 40 areas in order to earn NCQA’s seal of approval. And even more stringent standards are being developed today. These standards will promote the adoption of strategies that we believe will improve care, enhance service and reduce costs, such as paying providers based on performance, leveraging the Web to give consumers more information, disease management and physician-level measurement.
You play a role in making NCQA successful. Whether you’re a consumer, a legislator or an employer, the most valuable thing you can do is simply to use NCQA’s information — and encourage others to use it too. Doing so sends a powerful message: quality matters.
If you’re a provider or a health plan, we invite you to participate in our voluntary programs — doing so will help you achieve your potential and demonstrate to the world that you care about quality.
We would also appreciate your
feedback. Tell us how we can serve you better. Comments are always welcome
at customersupport@ncqa.org.
Visit NCQA
The Joint Commission
Mission: To continuously improve the safety and quality of care provided to the public through the provision of health care accreditation and related services that support performance improvement in health care organizations.
Positioning statement: Helping Health Care Organizations Help Patients.
The Joint Commission evaluates and accredits nearly 15,000 health care organizations and programs in the United States. An independent, not-for-profit organization, The Joint Commission is the nation’s predominant standards-setting and accrediting body in health care. Since 1951, The Joint Commission has maintained state-of-the-art standards that focus on improving the quality and safety of care provided by health care organizations. The Joint Commission’s comprehensive accreditation process evaluates an organization’s compliance with these standards and other accreditation requirements. Joint Commission accreditation is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards. To earn and maintain The Joint Commission’s Gold Seal of Approval™, an organization must undergo an on-site survey by a Joint Commission survey team at least every three years. (Laboratories must be surveyed every two years.)
The Joint Commission is governed by a 29-member Board of Commissioners that includes physicians, administrators, nurses, employers, a labor representative, health plan leaders, quality experts, ethicists, a consumer advocate and educators. The Board of Commissioners brings to The Joint Commission diverse experience in health care, business and public policy. The Joint Commission’s corporate members are the American College of Physicians, the American College of Surgeons, the American Dental Association, the American Hospital Association, and the American Medical Association. The Joint Commission employs approximately 1,000 people in its surveyor force, at its central office in Oakbrook Terrace, Illinois, and at a satellite office in Washington, D.C. The Washington office is The Joint Commission’s primary interface with government agencies and with Congress, seeking and maintaining partnerships with the government that will improve the quality of health care for all Americans, and working with Congress on legislation involving the quality and safety of health care.
The Joint Commission provides evaluation and accreditation services for the following types of organizations:
The Joint Commission also awards Disease Specific Care Certification to health plans, disease management service companies, hospitals and other care delivery settings that provide disease management and chronic care services. The Joint Commission also has a Health Care Staffing Services Certification Program and is developing a certification program for transplant centers and health care services.
For more information, see the fact sheets on “Benefits of Joint Commission Accreditation” and “Benefits of Joint Commission Certification.”
Joint Commission standards address the organization’s level of performance in key functional areas, such as patient rights, patient treatment, and infection control. The standards focus not simply on an organization’s ability to provide safe, high quality care, but on its actual performance as well. Standards set forth performance expectations for activities that affect the safety and quality of patient care. If an organization does the right things and does them well, there is a strong likelihood that its patients will experience good outcomes. The Joint Commission develops its standards in consultation with health care experts, providers, measurement experts, purchasers, and consumers.
Introduced in February 1997, The Joint Commission’s ORYX® initiative integrates outcomes and other performance measurement data into the accreditation process. ORYX measurement requirements are intended to support Joint Commission accredited organizations in their quality improvement efforts. Performance measures are essential to the credibility of any modern evaluation activity for health care organizations. They supplement and help guide the standards-based survey process by providing a more targeted basis for the regular accreditation survey, for continuously monitoring actual performance, and for guiding and stimulating continuous improvement in health care organizations. Some accredited organizations are required to submit performance measurement data on a specified minimum number of measure sets or non-core measures, as appropriate, to The Joint Commission through a Joint Commission listed performance measurement system. For more information, see “Facts about ORYX.”
Joint Commission Resources is a global, knowledge-based organization that provides innovative solutions designed to help health care organizations improve patient safety and quality. An affiliate of The Joint Commission, JCR is the official publisher and educator of The Joint Commission. JCR provides expertise on the many issues organizations face in a challenging health care environment and offers: education programs, publications and multimedia products, its Continuous Service Readiness initiative, comprehensive health care consulting and custom education, and accreditation and international consulting for organizations abroad. The Joint Commission and JCR maintain strict policies that prohibit The Joint Commission from sharing any confidential information about accredited organizations with JCR. The fact that an organization has obtained services from JCR is kept completely separate from Joint Commission accreditation decisions.
The Joint Commission provides a comprehensive guide to help individuals learn more about the safety and quality of Joint Commission accredited health care organizations and programs throughout the United States. Quality Check®, located at www.qualitycheck.org, includes each accredited organization’s most recent Quality Report. This report provides: detailed information about an organization’s performance and how it compares to similar organizations; the organization’s accreditation decision and the effective dates of the accreditation award; programs accredited by The Joint Commission, and programs or services accredited by other accrediting bodies; compliance with The Joint Commission's National Patient Safety Goals; special quality awards; and, for hospitals, performance on National Quality Improvement Goals. For more information, see “Facts about Quality Check® and Quality Reports.”
The Joint Commission website includes an extensive directory; just click on “Contact Us.” The general phone number is (630) 792-5000 and the Customer Service number is (630) 792-5800.
Vist them on the Internet at http://www.jointcommission.org/
URAC
URAC, an independent, nonprofit organization, is well-known as a leader in promoting health care quality through its accreditation and certification programs. URAC offers a wide range of quality benchmarking programs and services that keep pace with the rapid changes in the health care system, and provide a symbol of excellence for organizations to validate their commitment to quality and accountability. Through its broad-based governance structure and an inclusive standards development process, URAC ensures that all stakeholders are represented in establishing meaningful quality measures for the entire health care industry.
To promote continuous improvement in the quality and efficiency of health care management through processes of accreditation and education.
In the late 1980's concerns grew over the lack of uniform standards for utilization review (UR) services. UR is the process where organizations determine whether health care is medically necessary for a patient or an insured individual. As a result, URAC's first mission was to improve the quality and accountability of health care organizations using UR programs. In later years, URAC's mission expanded to cover a larger range of service functions found in various health care settings including the accreditation of integrated systems such as health plans to smaller organizations offering specialty services. Now, in its 14th year of operation, URAC has over 16 accreditation and certification programs.
From conception, the founders of URAC recognized that an accreditation organization would not be accepted by regulators, health care providers and consumers if controlled by industry interests. To avoid this, several operating principles were incorporated into URAC's structure and bylaws. First, URAC was set up as an organization independent of any particular stakeholder group. Second, the governing Board of Directors was established with representatives from all affected constituencies: consumers, providers, employers, regulators and industry experts. Today, over 500 committee volunteers and 30 paid staff help run the organization.
URAC is one of the fastest growing health care accreditation agencies in the world. URAC will continue to develop new standards for the health care system and revise existing ones to promote national standards and to ensure that all stakeholders, including consumers and providers, are protected.
What is accreditation?
Accreditation is a process by which an impartial organization (URAC) will review
a company's operations to ensure that the company is conducting business in a
manner consistent with national standards.
What does "URAC" stand for?
Originally, URAC was incorporated under the name "Utilization Review
Accreditation Commission." However, that name was shortened to just the
acronym "URAC" in 1996 when URAC began accrediting other types of
organizations such as health plans and preferred provider organizations.
Who does URAC accredit?
URAC accredits many types of health care organizations. It depends on the
functions they carry out. We have a number of different accreditation programs,
some that review the entire organization, such as the health plan standards, and
some that focus on quality within a single functional area in an organization,
e.g. case management or credentialing.
How many organizations are accredited,
and in what states?
URAC is the largest accrediting body for health care. We accredit programs that
do business in every state. All of URAC's accredited companies are listed on
this Web site. Check out the accredited companies link. You can search by state
or by company name.
Is URAC accreditation accepted
Nationwide?
Yes. Some states also "recognize" URAC accreditation, meaning that the
accreditation can be used to meet state regulatory requirements instead of
separate reporting to the state. A few states require URAC accreditation in
order for companies to do certain types of business.
Who develops URAC's standards?
URAC standards are developed by a committee of experts representing diverse
interests in the health care community: providers, health care organizations,
insurers, and the public interest. When new standards are developed, experts
from that particular area of health care delivery participate on the committee.
URAC always circulates draft standards for public comment so that anyone can
have input in the standards development process.
How often does URAC update the standards?
Generally, URAC updates its standards every three years. Occasionally changes in
the health care environment necessitate making a change in the interim. URAC's
Standards Committee recommends changes, which then go to URAC's Board of
Directors for approval.
You can view URAC on the Internet at :http://www.urac.org/