Category: Informative

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Quality control and assessment have become very common all spheres of the economic growth. Several organizations have sprung up to accredit quality services and products in healthcare. National Committee for Quality Assurance (NCQA) is one of these accreditation organizations in the United States. NCQA is not-for-profit organization that was founded in 1990. In order to achieve its mission of improving quality of the health care developed several guidelines by which it evaluates the performance of different healthcare providers (NCQA).

National Committee for Quality Assurance’s Role

NCQA plays the role accrediting health care service providers through thorough assessment of their health care service delivery against some predefined quality measures. It acknowledges quality healthcare providers by the use organization’s seal. As such, NCQA plays mobilization and monitoring roles in regard to healthcare quality and safety. In order to meet this end, the NCQA cooperate with major stakeholders in healthcare such as doctors, healthcare employers, policymakers, health plans and patients to pin point the most important issues and variables in order to establish appropriate parameters of measuring such variables. The ultimately goal of such deliberations is to ensure continuous improvement in the nation’s health sector (Scanlon, Darby, Rolph & Doty, 2001).

NCQA’s Guidelines

The national Committee for Quality Assurance uses the predefined guidelines to measure, analyze and evaluate the health care entities, as the health care quality yard stick. To ensure the safety of health care services consumers, the NCQA is entrusted by the responsibility of satisfying healthcare products by comprehensively and rigorously reviewing the providers of such services and products. The use of the NCQA seal is a mark of quality of such products and services (Byers & White, 2004). The employers and consumers are therefore assured of the quality of services and management in the organizations endorsed by the seal. Additionally, NCQA reports annually on the performance of different healthcare providers while highlighting possible areas of improvement by such health care providers (Sherwood, 2012).

In its Health Plan Employer Data and Information Set (HEDIS), NCQA currently has more than sixty guidelines by which it measures quality of health care services. According to NCQA, any healthcare service provider cannot get the NCQA seal without reporting quality performance in more than forty of these standards. These HEDIS guidelines are grouped into sections to measure the effectiveness of the healthcare, patients’ satisfaction with the healthcare experience, accessibility and availability of the healthcare, the stability of the plan, informed healthcare choices, cost of the healthcare, and the descriptive information of the health plan (Scanlon, Darby, Rolph & Doty, 2001).

Strengths and Limitations of the Guidelines

In addition to this comprehensive nature of its guidelines, NCQA has also been applauded for the soundness of its quality measure guidelines. The NCQA’s guidelines in measuring healthcares effectiveness by the use cancer screening parameter stands out as one of its strong features. As opposed to the old trend where retinopathy was the only measure of diabetes, the current HEDIS considers cervical cancer screening, breast cancer screening, and colorectal cancer screening as three guidelines of determining the effectiveness of healthcare services (NCQA, 2012).

On the other hand, there are several weaknesses in the NCQA’s guideline for evaluating the effectiveness of diabetes care. Even though the guideline clarifies different criterion for this measure, there is the difficulty of obtaining such information in addition to the high cost of retrieving data from medical chart reviews (Scanlon, Darby, Rolph & Doty, 2001). This makes this guideline unrealistic or difficult to come by.

As pointed out by Kuhlthau and his colleagues (1998), the NCQA’s guidelines have several glaring weaknesses, especially concerning the coverage of children with chronic condition. This guideline treats children in a single-condition term, like adults, whereas children usually face multiple conditions compared to the adults. Given that children are under the care of adults, these guidelines should have been formulated in the context children’s family.


Despite the weaknesses witnessed in the NCQA’s guidelines, this organization’s HEDIS measures still remains as the most effectives guidelines among the accreditation bodies. Monitoring and guiding quality improvement in the health care should always be prioritized in order to ensure the safety of patients and effectiveness of the United States’ health plans.

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