The University Record, March 12, 1996

M-CARE receives one-year NCQA accreditation

M-CARE, the managed care organization designed by the University of Michigan, has received a one-year accreditation for its HMO product from the National Committee for Quality Assurance (NCQA).

NCQA accreditation is a nationally recognized evaluation that health care purchasers, regulators and consumers can use to assess managed care plans. The accreditation evaluates how well a health plan manages all parts of its delivery system---physicians, hospitals, other providers, and administrative services---in order to continuously improve health care for its members.

NCQA is an independent non-profit organization established in 1979 that reviews and accredits managed care plans based on six quality standards, such as the plan's encouragement of its members to have preventive tests and immunizations. NCQA is governed by a board of directors that includes managed care executives, purchasers, independent quality experts and union and consumer representatives.

"NCQA spent a number of days on site reviewing our quality assurance, utilization management and credentialing programs as well as our preventive health services, medical records and the rights and responsibilities of our members," says Linda G. Ziesmer, M-CARE's director of quality improvement. "After the site visit, M-CARE's performance was compared to NCQA's standards that emphasize both quality of care and quality improvement."

One-year accreditation is granted to plans that have well-established quality improvement programs and meet most NCQA standards. NCQA provides the plans with a specific list of recommendations and reviews the plans after a year to determine if they have progressed enough to full accreditation status. NCQA has granted a one-year accreditation to about 40 percent of the HMOs that have applied for accreditation.

"The benefit of NCQA accreditation is really two-fold," Ziesmer says. "First, and perhaps most important, it demonstrates to our HMO members and prospective members that the plan has met some extremely high quality standards that were set by an independent, objective third party. Second, it's a clear indication to any employer groups currently offering or considering offering our HMO product that M-CARE is committed to providing quality care at affordable prices."

M-CARE, which is based in Ann Arbor, currently has more than 87,000 members and contracts with nearly 500 employer groups. The organization also has field offices in Southfield, Jackson, Lansing and Flint. M-CARE has more than 3,000 physicians and more than 40 hospitals in its provider network. The organization currently offers HMO, Point of Service, and Medicaid health plans, and is developing a Medicare plan.