Quality Improvement Essay

Appropriate accrediting body

The appropriate accrediting body is the National Committee for Quality Assurance (NCQA). This is a private, not-for-profit organization that was formed with the intention of improving health care quality. Its mission is to improve the quality of health care, while its vision is to achieve better health care, better choices and better health. As an accrediting organization, NCQA efforts are targeted at pointing the way to using evidence and science in improving health care, studying how well health plans and medical personnel provide scientifically recommended care, and identifying organizations that are run in ways that improve care. Through its efforts, the organization has saved many lives, helped millions of people to stay healthy, and saved money. Prior to the NCQA being formed and becoming operational, data was not a key feature in health care improvement efforts. In fact, there was not much communication among health care organizations with regards to quality improvements. With NCQA coming into being, quality improvement was better organization as the organization applied measurement, transparency and accountability to highlight the top performing organizations and drive improvements (National Committee for Quality Assurance, 2021).

Founded in 1990, the NCQA has been a leading figure in accrediting health care organizations for their efforts in elevating health care quality as a top agenda, and driving improvements through health care systems. The organization’s efforts are built around consensus with stakeholders (such as medical personnel, patients, policy makers, employers and others) on important health care quality issues. The consensus focuses on decisions regarding what metrics are important, how to measure the metrics, and how to promote improvements. Quality Improvement Essay  The organization presents services and programs that reflect a clear health care improvement formula. This formula goes through a four step-process: measuring, analyzing, improving and repeating. The organization applies the formula and process through developing performance measures and quality standards. The measures and standards are the tools that health care organizations and individuals apply to identify improvement opportunities. Organizations accredited and certified by NCQA are required to make annual performance reports against the measures and standards, with the results used to set improvement agendas in the following year. Other than accrediting heath care organizations, NCQA also recognizes practices and clinicians in key performance areas (NCQA Blog, 2022).

Obtaining accreditation

NCQA has a health plan accreditation program. This is an evidence-based program that is dedicated to quality measurement and improvement. The program provides a comprehensive framework that helps health care organizations to align and improvement their operations in performance areas that are most important to the stakeholders who include employers, government and patients. The NCQA accreditation is managed through an evaluation program whose results are based on actual measurements of consumer experiences (CAHPS measures) and clinical performance (HEDIS measures). Health care organizations that are part of NCQA health plan accreditation program apply the program standards to performance gap analysis and determine areas that can be improved. The program and its standards provides a framework for implementing evidence-based best practices that sees improvements in Medicaid service requirements, member connections, members’ rights and responsibilities, credentialing and re-credentialing processes, utilization management processes, practitioner network and access to care, population health management, and quality improvement process (National Committee for Quality Assurance, 2021b).

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NCQA accreditation has requirements that act as a roadmap for organization improvement. The health care organization uses the requirements as a roadmap to perform gap analysis and align improvement activities with the areas that are most important to the stakeholders, such as patient protection and network adequacy. The organizations that are eligible for the health plan accreditation program must meet a set criterion. Firstly, they must operate under an insurance license, such as EPO, PPO, POS and HMO. Secondly, they must have a contract for insurance for a defined population, or contracts with an employer to provide managed care services for a population that is self-insured. Thirdly, the organization must provide medical services through an organized delivery system that includes inpatient and ambulatory health care sites. Fourthly, the organization must perform the functions addressed in the accreditation standards. It must perform the functions either directly or through a service agreement. Fifthly, it must have a monitoring and evaluation process for improving the safety and quality of care provided. Finally, it must report audited results for designated CAHPS composites and ratings, and HEDIS measures as required (National Committee for Quality Assurance, 2021b).

Organizations that meet the accreditation requirements to include the criterion can go through the process of earning the NCQA health plan accreditation. Towards this end, the first step involves having a discussion with a program expert designated by NCQA. The expert leads an overview consultative discussion. The second step is to purchase and review the resources in the program. This requires that the organization purchase the standards and survey tool. The third step is to conduct a gap analysis by comparing the NCQA standards against the current processes and performance at the organization. The fourth step is to submit a pre-application form that informs the NCQA of the intention to be accredited. The fifth step is to align the organization with the NCQA program requirements and standards. The final step is the NCQA conducting a survey after which the accreditation is issued should the organization pass so that the organization earns the health plan accreditation (National Committee for Quality Assurance, 2021c).

Quality Improvement

The performance and quality metrics to focus on is in the three domains of: access/availability of care; experience of care; and measures reported using electronic clinical data systems, particularly the use of telehealth services. In the face of Covid-19 pandemic, the hospital facility has implemented the recommended pubic measures to curtail the spread of the virus. A key measure applied at the facility is social distancing with patients encouraged not to visit the hospital for routine services unless absolutely necessary. To ensure that patients continue to receive health care services even from home, the hospital has expanded its telehealth capacity so that patients can still be monitored from home without having to visit the hospital. The telehealth metrics evaluate the telehealth networks, particularly the capacity to provide coordinated, equitable and safe care by credentialed medical personnel. The metrics would focus on six standards. Firstly, telehealth access and equity. Secondly, credentialing for providers. Thirdly, member experiences to include complaints. Fourthly, care coordination in terms of information sharing, tracking and follow up. Fifthly, patient safety and effectiveness. Finally, platform capabilities to include disclosures and how health information will be used. Submitting this information to the NCQA would help with the health plan accreditation for telehealth services (National Committee for Quality Assurance, 2020).

Financial impact

Quality performance in telehealth services or any other area has a financial impact on the organization. Firstly, it results in reduced costs of patient care. A telehealth program that performs at the desired quality level is able to allow patients to avoid visiting the facility without compromising their care thus effectively reducing the cost of care. Secondly, it results in reductions for overall operating costs at the organization. Through investment in telehealth program, the organization can reduce investments in protecting patients visiting the facility from Covid-19 infections. That is because fewer patients will be visiting the facility. Thirdly, it increases reimbursements for patient care as the patients will have greater access to care. Fourthly, it enhances healthcare through ensuring that healthcare needs are anticipated and met on time. Finally, it will allow the organization to receive funding from government agencies and private foundations that support telehealth programs (Penner, 2017).

Position

NCQA accreditation standards for the telehealth program are necessary for helping the organization to align future initiatives with issues that are relevant to the stakeholders. Through taking the telehealth program through the NCQA accreditation process and its comprehensive framework, a gap analysis will be performed to help in identifying areas that can be improved through evidence-based practices. In addition, the accreditation occurs through consumer experiences and clinical performance, and this signals the organization’s commitment to quality measures and best practices.

Conclusion

One must accept that NCQA is an appropriate accrediting body since it applies a framework that focuses on improving health care quality. In addition, one must acknowledge that the accreditation program involves meeting six criteria for eligibility, and a six-step accreditation process. Also, the NCQA accreditation is relevant for evaluating the telehealth process as it would help in improving quality performance, and consequently improving financial performance by reducing cost of patient care, reducing overall operating costs, increasing reimbursement for patient care, enhancing health care, and receiving funding from government agencies and private foundations that support telehealth programs. Overall, going through the NCQA accreditation for the telehealth program would help to improve quality through gap analysis and evidence-based practices, and signal the organization’s commitment to quality measures and best practices.

References

National Committee for Quality Assurance (2020). Telehealth Module in Health Plan Accreditation: Overview. https://www.ncqa.org/wp-content/uploads/2020/11/20201117_Overview_Memo_Telehealth_Module.pdf

National Committee for Quality Assurance (2021a). About NCQA. https://www.ncqa.org/about-ncqa/

National Committee for Quality Assurance (2021b). Health Plan Accreditation FAQs. https://www.ncqa.org/programs/health-plans/health-plan-accreditation-hpa/faqs/

National Committee for Quality Assurance (2021c). Health Plan Accreditation Process. https://www.ncqa.org/programs/health-plans/health-plan-accreditation-hpa/process/

NCQA Blog (2022). About the National Committee for Quality Assurance (NCQA). https://blog.ncqa.org/about-ncqa/

Penner, S. J. (2017). Economics and financial management for nurses and nurse leaders (3^rd ed.). Springer Publishing.

Assessment Description

Write a 1,250-1,500-word essay about quality improvement. Include the following points in your essay:

1. Evaluate which accrediting body would be most appropriate for your health care organization.
2. Summarize the requirements to obtain accreditation.
3. Based on your research and experience, what performance or quality metrics could you focus on for a quality improvement project to present to the accrediting body?
4. How does the quality performance financially impact the organization?

Include at least three references, including the textbook.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.  Quality Improvement Essay