Summary: The link between healthcare exchanges and NCQA resides in the requirement for exchanges to be accredited. NCQA is one of the national healthcare accreditation organizations which has been given deeming status to grant accreditation to healthcare insurance exchanges.

So, what is an exchange?

An exchange is an organization setup to create a more organized and more competitive market for buying health insurance. The exchanges are a part of the Affordable Care Act and are scheduled to become effective in 2014. The key to the success of this program is the state exchanges must be nationally accredited. This is where NCQA comes into play.

NCQA is a nationally recognized healthcare accreditation organization with many accreditation programs in place. NCQA accreditation carries an air of prestige. Accreditation tells the entire nation that quality and patient safety are first and foremost. Accreditation provides a competitive edge. Consumers are much more savvy than ever before. They crave data on many different facets of an organization so an informative choice can be made, in this case, choosing a health exchange.

What is the premise of the Healthcare Exchanges and NCQA?

The premise is to drive competition on the basis of value. Value is defined as spending less for high quality care. Careful attention will need to be applied when choosing a plan. You will need to make sure you are applying an apples to apples approach when comparing plans. A lower premium doesn’t always equate to the same level of quality.

What is the Healthcare Exchange and the NCQA role in driving competition based upon value?

Healthcare Exchanges and NCQA

Healthcare Exchanges and NCQA

NCQA can offer the following assistance to states in order to assist in the exchange building process:

  1. Presenting plan choices in a way that can easily be understood to give consumers the tools to compare plans.
  2. Providing education to navigators and brokers to utilize information on total costs as well as quality.
  3. Creating tools which can provide recommendations on plans which provide high value.
  4. Selecting a high value plan for those who don’t wish to choose one themselves.

NCQA will also offer a rating system for health plans to rate plans based upon both quality and cost.

NCQA will accredit plans. The federal requirements were actually modeled after NCQA’s program.

NCQA will assist plans in achieving higher value.

The bottom line is NCQA’s exchange accreditation already meets the regulations as set forth in the Affordable Care Act. They  are ready to assist you with all of your health insurance exchange accreditation needs.


BHM Healthcare Solutions welcomes any and all comments. We want to know what you think. Do you think Exchanges are the way to go? Do you think the regulations need to be revised? If so, what parts? What do you see as the pros and cons?

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