2002: NCQA Earns Medicare+Choice Deeming Authority

25 for 25: A series of 25 blog posts marking NCQA’s 25th anniversary. As part of our anniversary celebrations, NCQA will post a series of 25 blog posts highlighting milestones in our 25 years of improving health care quality.

2002-1

A rule of NCQA’s Accreditation process has always been “make it as efficient as possible.” Reviewing the same systems twice or having multiple teams conduct overlapping surveys wastes resources and does little to improve quality.

In early 2002, NCQA saw an opportunity to help health plans eliminate a redundancy: the Medicare+Choice survey that many plans were required to undergo as a condition of participating in Medicare’s managed care program (Medicare Advantage). At the time, Medicare offered qualified independent accreditors the opportunity to earn “deemed status,” a designation signifying that reviews by deemed accreditors could effectively substitute for all or part of a Medicare site visit.

NCQA developed a separate Medicare deeming module—several dozen standards that mirrored Medicare’s requirements—that could be added to a plan’s NCQA Health Plan Survey for a nominal fee.

The effort proved worthwhile. NCQA was the first organization to earn deemed status, and health plans participating in our survey process certainly took note: more than 80% of plans that offered a Medicare+Choice product opted to include the extra module as part of their survey. Early participants told NCQA that they appreciated both the clarity of the requirements and the predictability of the survey process.

Then-CMS Administrator Tom Scully remarked at the time, “NCQA has earned the right to help us [review Medicare+Choice plans], and we’re looking forward to the efficiencies this will introduce into the oversight process.”

NCQA still works hard to make oversight as efficient (and thorough!) as possible.

A cornerstone of NCQA’s 25th anniversary year will include a look ahead through the eyes of tomorrow’s leaders. This November 9, NCQA will convene Quality Talks: Inspiring the Future of American Health Care, a “TED-style” symposium held at the Knight Conference Center at the Newseum in Washington, DC. bringing together hundreds of health care and public policy professionals, including government regulators, thought leaders and Congressional staff.

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