The role of accreditation in a changing healthcare system

In October of this year, millions of Americans are expected to begin enrolling in health plans offered through new health insurance marketplaces. The Administration recently released proposed rules governing the design of health plans on exchange markets, including private-sector accreditation.
 
Private-sector accreditation will be mandatory for health plans offered on marketplaces. This signals the Administration’s strong commitment to market-based, best practices for health insurance marketplaces, including the critical consumer protections offered by private-sector accreditation.

Well-established, private-sector accreditation programs with meaningful quality measures help foster continuous quality improvement by health plans and are an important complement to rigorous state and federal regulation of health plans. In the private sector, many large employers use private-sector accreditation of health plans as a condition of contracting. 
 
Private-sector accreditation focuses on access and quality issues that matter most to patients, including timely access to services, high quality of care, and consumer protections when interacting with health plans. At URAC, one of the nation’s largest accrediting bodies, the process for developing accreditation standards and quality measures is very inclusive, with active input from a broad range of stakeholders, including consumers, physicians, hospitals, labor unions, pharmacists, nurses, employers, and the National Association of Insurance Commissioners. This consensus-oriented approach to standards-setting is a model for quality improvement and will serve consumers well as they consider enrollment in a marketplace plan.
                                                                           
Non-proprietary, publicly available, and widely accepted quality measures are also critical to achieving system-wide improvements, including measures used for individuals enrolled in marketplace plans. Yet, measurement alone yields an incomplete picture. Private-sector accrediting bodies must change with the times and that means also being able to provide health plans and marketplaces with sophisticated data-analytic tools that help measure and improve care quality and patient satisfaction. Measurement alone is insufficient – the data should also help pinpoint gaps in care and how best to take corrective action. This ability to continuously track and improve performance is a foundational goal of health care reform and one that must be embraced.
 
In 2011, our nation spent an estimated $2.7 trillion on health care. Numerous data show that hundreds of billions of dollars is spent every year on care that is wasteful, redundant, or inefficient. Enhanced data collection and quality improvement processes are a critical link to recouping these resources and generating better patient outcomes.
 
Private-sector accreditation is not the proverbial silver bullet to generating greater value in health care – no one thing is – but it can and should play an important role. This fall, millions of Americans will begin enrolling in marketplace plans that have been subject to the same strict government review and accreditation standards as commercial health plans. And that’s important progress.
 
Jones is chairman of the Board, URAC.

---