If you have made healthcare a career then you are likely to be familiar with NCQA. They’ve been around since the early 1990s measuring and then accrediting health plans. The NCQA designation continues to do for healthcare what the Good Housekeeping Seal of Approval does (since 1885) for home products…. spotlighting those organizations / manufacturers that meet exceptional quality standards. NCQA uses measurements, transparency and accountability to not only recognize top health plans, medical providers, and practices but to drive ongoing improvement.
It is with some surprise that NCQA has announced that it will start to offer an accreditation in specialty pharmacy as detailed in the press release below. First, there are a number of highly reputable accrediting organizations that health plans and manufacturers are familiar with and, more importantly, trust. Secondly, there has been a decline in the number of pharmacies breaking into specialty, so, attracting new signups may prove to be a challenge (refer to last week’s Report on URAC accreditations and discounts through ABC).
When a new competitor enters the market, they usually seek to differentiate themselves. But the key differentiation highlighted in the press release relates to value-based contracting (VBC). To be sure, VBC is an admirable quality measure…. but it is still a somewhat minor piece in the specialty pharmacy model.
It will be interesting to see if NCQA SP accreditation is embraced by the marketplace. Since most SPs already have several accreditations the big question will be “Is there room for one more?”
New NCQA Program Highlights Specialty Pharmacies for Commitment to Quality
WASHINGTON, Aug. 10, 2021 /PRNewswire/ — Today NCQA launched Specialty Pharmacy Accreditation, a service to help distinguish quality leaders and support value-based contracting in the rapidly growing field of specialty pharmacy.
“Specialty Pharmacy Accreditation addresses intersecting needs,” said Brad Ryan, MD, Chief Product Officer of NCQA. “Specialty pharmacies want to showcase their quality to stand out from peers so they can gain access to networks and pharmaceutical products. Drug manufacturers want to trust a specialty pharmacy can manage their products appropriately. And payers want to trust a specialty pharmacy can provide quality care to their members.”
In addition to helping pharmacies demonstrate their commitment to quality improvement and show they can be strong partners for value-based contracts, the new program helps pharmacies identify barriers to therapy initiation and adherence.
Organizations interested in NCQA Specialty Pharmacy Accreditation also stand to make meaningful improvements and contributions to quality by participating in a first-of-its-kind Measurement Lab.
The NCQA Specialty Pharmacy Measurement Lab is a collaborative working group composed of quality leaders from specialty pharmacies, health plans, pharmacy benefit managers, manufacturers and other industry stakeholders. Measurement Lab members learn best practices, pilot performance measures and influence the creation of digital measures as benchmarking and performance-based accreditation evolve.
Diverse organizations like those comprising the Measurement Lab helped design the new accreditation program. Organizations NCQA consulted include 11 specialty pharmacies, 9 health plans, 9 drug manufacturers, 6 pharmacy benefit managers and 3 patient advocacy groups. A 14-member Advisory Committee representing those industries—plus academia and CMS—developed the accreditation standards.
Pharmacies meet standards in four areas to earn Specialty Pharmacy Accreditation:
Patient Programs standards evaluate how well pharmacies support patients through the script journey—how patient-centered a pharmacy is and how it ensures patients experience their medications’ intended benefits.
Organization, Administration and Compliance standards evaluate how pharmacies train their staff and align with regulators and other stakeholders.
Specialty Pharmacy Operations standards consider how well pharmacies procure, secure, dispense and ship products to ensure product integrity.
Quality and Performance Improvement standards unify and build on the previous three standards to assess how pharmacies organize and measure continuous improvement.
Eligible organizations are licensed pharmacies that contract with drug manufacturers, health plans or pharmaceutical benefits managers to dispense specialty medications and provide supporting services. Accreditation surveys, which may be virtual or in-person, will begin in early 2022. NCQA determines accreditation status within 34 days after a survey. Specialty Pharmacy Accreditation lasts three years.
About NCQA
NCQA is a private, nonprofit organization dedicated to improving health care quality. NCQA Accredits and Certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care. NCQA’s website (ncqa.org) contains information to help consumers, employers and others make informed health care choices. NCQA can also be found on Twitter @ncqa, on Facebook at facebook.com/NCQA.org and on LinkedIn at linkedin.com/company/ncqa.
