Summary: What is the value of healthcare accreditation? Who are the major players? What are the differences? What is the difference between Accreditation, Recognition, and Certification? Are they the same? Are they synonymous?
There are 5 major healthcare accreditation organizations in the United States:
- URAC uses this term accreditation for their programs. URAC accreditation is defined by the URAC website as “a process by which an impartial organization (URAC) will review a company’s operations to ensure that the company is conducting business in a manner consistent with national standards. URAC has more than 25 types of accreditation including PCHCH Accreditation, Independent Review Organizations (sometimes referred to as Physician Advisor Services), Health Plan, Health Web Site, PCHCH Auditor Certification, and Drug Therapy Management (just to name a few, as they have an extensive list).
- NCQA Accreditation refers to “support continuous improvement in plans’ quality and value”. Some of their accreditations include: Accountable Care Organizations, Health Plan Accreditation, Wellness and Health Promotion, Case Management Accreditation, Managed Behavioral Healthcare Organizations, New Health Plans, Disease Management, and Accreditation Users Group
- TJC Accreditation is used to indicate a particular program and is characterized by the type of organization. Accreditation may be achieved for: Ambulatory Health Care, Behavioral Health Care, Critical Access Hospitals, Home Care, Hospitals, International Accreditation, Laboratory Services, Nursing and Rehabilitation Center, and Office-Based Surgery.
- CARF Accreditation is used to denote different types of programs. The CARF accreditations include: Aging Services, Behavioral Health, Business and Services Management Network, CARF-CCAC, Child and Youth Services, DMEPOS, Employment and Community Services, Medical Rehabilitation, One-Stop Career Center, Opioid Treatment Program, and Vision Rehabilitation Services.
- COA accredits organizations surrounding child welfare, behavioral healthcare, and community based social service programs to children, youth, adults, and families. COA Accreditation programs include: Private Organization Accreditation, Public Agency Accreditation, Canadian Organization Accreditation, After School Program Accreditation, Military and Family Readiness Program Accreditation, Hague Accreditation and Approval, and Quality Childcare Expansion Accreditation.
- NCQA represent a subset of accreditation products as listed above. They pertain to services as opposed to programs. The current certification programs consist of: Credentials Verification Organization, Disease Management, Health Information Products, Multicultural Health Care, Physician and Hospital Quality, PCMH Content Expert Certification, Utilization Management and Credentialing, and Accreditation Users Group.
- TJC uses this term to denote chronic diseases and conditions. The certification programs consist of: Advanced Certification, Disease-Specific Care, Health care Staffing Services, and International Certification.
- NCQA uses the term recognition to “empower employers, health plans, patients and consumers to make informed health care decisions based on quality. The recognition programs consist of: Patient-Centered Specialty Practice Recognition Programs, Patient Centered Medical Home (PCMH-2011), Government Recognition Initiative, Diabetes Recognition Program, Heart/Stroke Recognition Program, Physician Practice Connections, and Back Pain Recognition Program.
- COA uses the term recognition to denote how they are recognized as opposed to how they recognize a program. Recognitions include such things as: deemed status, mandate, quality rating systems, tiered reimbursement systems, and training and/or financial support.
As you can see, the terms are not necessarily synonymous. Each organization uses these terms differently.
Are you in the process of seeking accreditation or re-accreditation? Are you in need of URAC consultants? Are you in need of an NCQA Consultant? Are you in need of TJC Accreditation Consulting? Are you in need of CARF Accreditation Consultants? Are you in need of COA consulting? If you answered yes to any of these questions, please call BHM Healthcare Solutions at 1-888-831-1171 or email us at email@example.com. We look forward to hearing from you.