Accredit Managed Care Organizations SL - Essay Example

Health Sciences and Medicine of Purpose of Accreditation Accreditation is a rigorous examination of a health care organization’s systems and processes to ensure adherence to set standards. An impartial external body carries out the accreditation process. Accreditation acts as a form of external approval of standards and services offered by an institution (NCQA, 2008). As the health care industry has become more and more competitive, accreditation has become more necessary. With accreditation, organizations can prove their commitment to accountability and quality services (URAC, 2011).

The process of accreditation has seen an improvement in the services patients receive from facilities. Since the organizations want to acquire and maintain accreditation, they improve the standards of their services. In so doing, patients end up getting improved care, which is to their benefit.2. NCQA Accreditation ProcessThe process of accreditation by NCQA is in two parts. The basis for assessment of each plan is on standards and healthcare effectiveness data and information set (HEDIS). Standards involve the evaluation of the structure and process of a plan in the maintenance and improvement of quality.

HEDIS involves evaluating the performance of a plan with regard to the process and outcomes in member experience of care as well as outcomes in clinical care (NSQA, 2008). The NCQA carries out its survey through onsite and offsite evaluations. In the offsite evaluation, the team of surveyors assesses the self-evaluation and other materials that concern the plan. The materials required for the process are accessible through the Interactive survey System, through which the institutions make submissions.

The team reviews the plan’s documents, which the institution submits, against standards to ascertain compliance. When evaluating standards, NCQA focuses on quality management and improvement, utilization management, credentialing, as well as member connections. The Healthcare Effectiveness Data and Information Set on its part assesses areas of care (NCQA, 2008). It focuses on preventive services such as immunization, treatment of acute diseases, management of chronic ailments as well as patience experience.3. Standards NCQA Checks On-SiteDuring the on-site review, NCQA assesses various areas of operation as well as documents and material that the institution may not be able to submit through the Interactive Survey System.

That includes confidential documents such as minutes of meetings or actual case records. The team of managed care experts and physicians assess the documents against the specifications of the plan as the institution describes it (NCQA, 2008). All these are assessed against set standards in a rigorous exercise that leaves nothing for chance.4. Handling of ResultsThe accrediting agencies do not publicize the findings of their surveys (Stiefel, 2010). However, from accreditation, one may conclude that a given institution satisfies set standards for the particular industry.

Information regarding adherence to standards would be of benefit to patients, as it would reveal the institutions that offer the best services as per laid set standards. Patients would be in a better position to choose institutions that beast serve their interests. Accreditation is a form of approval of an institution’s practices. Therefore, it would work as an endorsement for the institution. ReferencesNCQA (2008). Managed Care Organizations: Accreditation MCO. Retrieved from http://www.ncqa.

org/Portals/0/Marketing/AdGuidelines/MCOAccredGuidelines2008_12 _23_08.pdfStiefel, R. H. (2010). Analysis: New hospital accreditation agency falls short. Biomedical Instrumentation & Technology, 44(4), 328-30.URAC (2011). General Questions about URAC Accreditation. Retrieved from http://www.urac.org/accreditation/.