NUR 621 what is the difference between the National Committee for Quality Assurance (NCQA) and the Utilization Review Accreditation Commission (URAC)

NUR 621 what is the difference between the National Committee for Quality Assurance (NCQA) and the Utilization Review Accreditation Commission (URAC)

NUR 621 what is the difference between the National Committee for Quality Assurance (NCQA) and the Utilization Review Accreditation Commission (URAC)

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Health plans participating in the Affordable Care Act must be accredited; what is the difference between the National Committee for Quality Assurance (NCQA) and the Utilization Review Accreditation Commission (URAC)? Why would a health plan select one over the other?

Posted Date

Jan 19, 2022, 5:07 AM

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Replies to Beth Hale

KNOWLEDGE CHECK

What is the role of accreditation on quality? Provide one example to support your discussion.

REPLY

• CN

Jan 19, 2022, 4:23 PM

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Replies to Beth Hale

I think accreditation helps to improve the quality of services provided in the healthcare sector. Research has showed that healthcare facilities that are accredited provide a higher quality of care than those that are not accredited, which result in better patient outcomes. If a healthcare institution is not accredited, it does not have to maintain any standards of healthcare, because it does not have to any accrediting agency to critique its policy or procedures to a certain standard. As the saying goes” if there is no accountability there is no responsibility”.

Reference: NUR 621 what is the difference between the National Committee for Quality Assurance (NCQA) and the Utilization Review Accreditation Commission (URAC)

Akmal, A., Podgorodnichenko, N., Foote, J., Greatbanks, R., Stokes, T., & Gauld, R. (2021). Why is Quality Improvement so Challenging? A Viable Systems Model Perspective to Understand the Frustrations of Healthcare Quality Improvement Managers. Health Policy, 125(5), 658–664. https://doi.org/10.1016/j.healthpol.2021.03.015

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TF

Jan 16, 2022, 11:58 PM

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Replies to Beth Hale

Accountable Care Organization (ACO) consists of networks of providers that are rewarded financially if they can slow the growth in their patients’ healthcare spending while maintaining or improving the quality of care they deliver. For ACOs to be a success, there must be a collaboration of care. The goal of the ACOs is to provide well-coordinated, cost-effective care when clients need it. Under the Shared Savings Program, ACOs must meet several eligibility requirements, including providing certification to the Centers for Medicare and Medicaid Services (CMS) and their ACO application to be considered for and participate in this saving program (Strategic Management Services, 2022).

The National Committee for Quality Assurance (NCQA) is a private non-profit organization dedicated to improving healthcare quality (NCQA, 2022). The NCQA’s mission is to improve health care quality with the vision of better healthcare, better choices, and better health (NCQA, 2022). The NCQA developed quality standards and performance measures for a broad range of healthcare entities, and these tools helped organizations and individuals to identify opportunities for improvement (NCQA, 2022). The NCQA Health Plan Accreditation help to meet the goal of a plan that supports care that keeps members at an optimum level of health while controlling costs and meeting government and purchaser requirements (NCQA, 2021). Another accrediting body that helps to improve the quality of care is the Utilization Review Accreditation Commission (URAC). The URAC is one of America’s most prestigious accrediting organizations and non-profit accreditation entities that helps to improve the quality of care (URAC, 2022). The URAC’s renowned accreditation and certification programs set the highest standards in quality and safety (URAC, 2022).

 

Accreditation is essential in healthcare for accountability and to meet standards. Accreditation helps to improve healthcare quality and adherence (URAC, 2022). Health plans may choose one accrediting organization over another because of costs, accreditation process, recognition, and the different requirements needed to be accredited. Despite the choice of the accrediting body, the aim is to ensure high-quality care.

 

References NUR 621 what is the difference between the National Committee for Quality Assurance (NCQA) and the Utilization Review Accreditation Commission (URAC)

 

National Committee for Quality Assurance. (2021). Health plan accreditation. https://www.ncqa.org/programs/healthplans/health-plan-accreditation-hpa/

 

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

 

Strategic Management Services. (2022). Accountable care organizations: ACO final rule summary.

https://www.compliance.com/resources/accountable-care-organizations-regulations-aco-final-rule-summary/#aco-regulations

 

Utilization Review Accreditation Commission. (2022). About the URAC. https://www.urac.org/about/

REPLY

• BT

 

Jan 17, 2022, 7:17 PM

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Ho, Tameka,

Accreditation agencies are impartial organizations that oversee and evaluate the functioning of healthcare organizations to ensure they meet the pre-established performance standards. The accreditation agencies set quality standards and benchmarks to strengthen the organizations’ goals to deliver high-quality patient care. In addition, they oversee the functioning of organizations and physicians to evaluate their performance against the pre-established quality standards. With the paradigm shift from treatment and cure to prevention, health care organizations focus more on continuous quality improvement to promote positive patient outcomes. National Committee for Quality Assurance (NCQA) plays an accreditation role to organizations that incorporate medical groups, physician networks, and health plans such as PPOs and HMOs (Richter & Beauvais, 2018). It utilizes accountability, measurements, and transparency to identify the top healthcare performers and compel improvement. The private sector and the government clients seek the services of NCQA through grants and contracts to measure quality and provide the necessary improvements. NCQA focuses on HEDIS (Healthcare Effectiveness Data and Information Set) in addition to recognition and certification programs.

References NUR 621 what is the difference between the National Committee for Quality Assurance (NCQA) and the Utilization Review Accreditation Commission (URAC)

Richter, J. P., & Beauvais, B. (2018). Quality indicators associated with the level of NCQA accreditation. American Journal of Medical Quality, 33(1), 43–49. https://doi.org/10.1177/1062860617702963.

Denver, R. C. (2011). Accreditation to approve health plans and providers. National Conference of State Legislatures. https://www.ncsl.org/documents/health/HRHealthPlans.pdf.

Payne, J. (2018). A commitment to quality care: URAC accreditation for CA SB1160 and beyond. Mitchell. https://www.mitchell.com/insights/workers-comp/articles/commitment-quality-care-urac-accreditation-ca-sb1160-and-beyond.

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NUR 621 what is the difference between the National Committee for Quality Assurance (NCQA) and the Utilization Review Accreditation Commission (URAC) Grading Rubric Guidelines

Performance Category	10	9	8	4	0
Scholarliness Demonstrates achievement of scholarly inquiry for professional and academic decisions.	Provides relevant evidence of scholarly inquiry clearly stating how the evidence informed or changed professional or academic decisions Evaluates literature resources to develop a comprehensive analysis or synthesis. Uses valid, relevant, and reliable outside sources to contribute to the threaded discussion	Provides relevant evidence of scholarly inquiry but does not clearly state how the evidence informed or changed professional or academic decisions. Evaluates information from source(s) to develop a coherent analysis or synthesis. Uses some valid, relevant, reliable outside sources to contribute to the threaded discussion.	Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions. Information is taken from source(s) with some interpretation/evaluation, but not enough to develop a coherent analysis or synthesis. Little valid, relevant, or reliable outside sources are used to contribute to the threaded discussion. Demonstrates little or no understanding of the topic.	Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions. Information is taken from source(s) without any interpretation/evaluation. The posting uses information that is not valid, relevant, or reliable	No evidence of the use of scholarly inquiry to inform or change professional or academic decisions. Information is not valid, relevant, or reliable
Performance Category	10	9	8	4	0
Application of Course Knowledge – Demonstrate the ability to analyze, synthesize, and/or apply principles and concepts learned in the course lesson and outside readings and relate them to real-life professional situations	Posts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources; Applies concepts to personal experience in the professional setting and or relevant application to real life.	Posts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources. Applies concepts to personal experience in their professional setting and or relevant application to real life Interactions with classmates are relevant to the discussion topic but do not make direct reference to lesson content	Posts are generally on topic but do not build knowledge by incorporating concepts and principles from the lesson. Does not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real life Does not demonstrate a solid understanding of the principles and concepts presented in the lesson	Posts do not adequately address the question posed either by the discussion prompt or the instructor’s launch post. Posts are superficial and do not reflect an understanding of the lesson content Does not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real life	Posts are not related to the topics provided by the discussion prompt or by the instructor; attempts by the instructor to redirect the student are ignored No discussion of lesson concepts to personal experience in the professional setting and or relevant application to real life
Performance Category	5	4	3	2	0
Interactive Dialogue Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days. (5 points possible per graded thread)	Exceeds minimum post requirements Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts three or more times in each graded thread, over three separate days. Replies to a post posed by faculty and to a peer Summarizes what was learned from the lesson, readings, and other student posts for the week.	Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days Replies to a question posed by a peer Summarizes what was learned from the lesson, readings, and other student posts for the week.	Meets expectations of 2 posts on 2 different days. The main post is not made by the Wednesday deadline Does not reply to a question posed by a peer or faculty	Has only one post for the week Discussion posts contain few, if any, new ideas or applications; often are a rehashing or summary of other students’ comments	Does not post to the thread No connections are made to the topic
	Minus 1 Point	Minus 2 Point	Minus 3 Point	Minus 4 Point	Minus 5 Point
Grammar, Syntax, APA Note: if there are only a few errors in these criteria, please note this for the student in as an area for improvement. If the student does not make the needed corrections in upcoming weeks, then points should be deducted. Points deducted for improper grammar, syntax and APA style of writing. The source of information is the APA Manual 6th Edition	2-3 errors in APA format. Written responses have 2-3 grammatical, spelling, and punctuation errors. Writing style is generally clear, focused, and facilitates communication.	4-5 errors in APA format. Writing responses have 4-5 grammatical, spelling and punctuation errors. Writing style is somewhat focused.	6-7 errors in APA format. Writing responses have 6-7 grammatical, spelling and punctuation errors. Writing style is slightly focused making discussion difficult to understand.	8-10 errors in APA format. Writing responses have 8-10 grammatical, spelling and punctuation errors. Writing style is not focused, making discussion difficult to understand.	Post contains greater than 10 errors in APA format. Written responses have more than 10 grammatical, spelling and punctuation errors. Writing style does not facilitate communication. The student continues to make repeated mistakes in any of the above areas after written correction by the instructor
	0 points lost				-5 points lost
Total Participation Requirements per discussion thread	The student answers the threaded discussion question or topic on one day and posts a second response on another day.				The student does not meet the minimum requirement of two postings on two different days
Early Participation Requirement per discussion thread	The student must provide a substantive answer to the graded discussion question(s) or topic(s), posted by the course instructor (not a response to a peer), by Wednesday, 11:59 p.m. MT of each week.				The student does not meet the requirement of a substantive response to the stated question or topic by Wednesday at 11:59 pm MT.

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