Other Report Cards & Tools
Choosing a high-quality health plan and physician plays a useful role in assuring you and your family receives top-notch care. The Health Plan Report Card is a significant tool to help you in choosing the best health plan for your family. NCQA also provides several other free, online tools that demonstrate the quality of health plans, physicians and other health care organizations.
NCQA Health Insurance Plan Rankings:
This report provides a detailed and online ranking of over 700 health plans in the United States. Health plans are ranked according to a combined score of clinical performance, customer service and NCQA Accreditation. Consumer Reports Health republished NCQA’s rankings online and in its November issue of Consumer Reports magazine.
New Health Plan Status List
NCQA accredits health plans that are less than three years old under New Health Plan (NHP) Accreditation. NHP Accreditation evaluates how well a plan manages its clinical and administrative systems in order to continuously improve health care for its members.
Quality Dividend Calculator
This free online tool answers the question of whether quality health care really costs less. The calculator uses HEDIS health plan data and employer demographics to calculate increased productivity and revenues when selecting accredited plans. Used by employers nationwide, this tool quantifies how quality care keep employees healthy and on the job.
State of Health Care Quality
NCQA produces the State of Health Care Quality annually to monitor and report on performance trends over time, track variations in patterns of care and provide recommendations for future quality improvement.
Recognized Physician Directory
NCQA recognizes physicians and physician practices in several programs. Physicians voluntarily participate in these programs to demonstrate their commitment in delivering patients the best care possible. By searching NCQA’s Recognized Physician Directory you can find recognized physicians in the areas such as back pain, cardiovascular/stroke and diabetes care. Additionally, two programs, Physician Practice Connections and Physician Practice Connections – Patient-Centered Medical Home, recognize physician practices that create links between patients, physicians and patient information to deliver the right care to their patients.
Other Health Care Organizations:
NCQA accredits and certifies various types of health care organizations, all of which are maintained on NCQA’s complete Report Card Listing. Many times your health plan will contract with these organizations to provide you with high-quality clinical and administrative services. Included in this listing are the following report cards:
Credentialing and Utilization Management
This program comprises of two separate certifications. Organizations that typically are certified in these programs are specialty care organizations. Credentialing certification evaluates an organization’s ability to verify the credentials of health care practitioners and approve them to care for members. Utilization Management Certification evaluates the organization against standards for reviewing and determining coverage of members to assure appropriate use of services.
Credentials Verification Organizations
This certification program evaluates organizations that verify credentials of providers at health plans and hospitals. CVO certification is available to organizations that conduct credentials verification, report the credentialing information to clients and have systems in place to protect the confidentiality and integrity of the information.
This program offers accreditation and certification options to health plans and other types of organizations. Organizations are evaluated for comprehensive and disease-specific disease management functions.
Health Information Products
This program reviews organizations against standards for provision of members’ information and care management and health improvement.
Managed Behavioral Healthcare Organizations
This program accredits behavioral health care organizations. MBHO Accredited organizations have proven they have processes designed to monitor, evaluate and improve the quality and safety of behavioral health care provided to members.
This program evaluates physician organizations or large physician groups on three areas: utilization management, credentialing, and quality improvement. The areas are similar to subsets of Health Plan Accreditation but are specific to physician organizations.