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Grand Valley Health Plan - Accreditation

NCQA Accreditation

Grand Valley Health Plan has been granted an Excellent Accreditation status with National Committee for Quality Assurance (NCQA). This is the highest accreditation status that an organization can receive.

What does this mean to you?

The Excellent Accreditation status means that GVHP has demonstrated it has meaningfully improved the quality of health care and the level of service to our members. It's more than just a seal of approval. It's proof of quality improvement. NCQA's highest accreditation outcome is granted only to those plans that demonstrate levels of service and clinical quality that meet or exceed NCQA's rigorous requirements for consumer protection and quality improvement. Plans earning this accreditation level must also achieve HEDIS® results that are in the highest range of national or regional performance.

NCQA is a private, not-for-profit organization dedicated to improving the quality of health care. The organization's main activities are evaluating and reporting the quality of the nation's managed care plans. NCQA provides information that enables purchasers and consumers of managed health care to decide on plans based on quality, which allows them to make more informed health care purchasing decisions. This encourages health plans such as GVHP to compete based on quality and value, rather than on price and provider network.

In order for GVHP to become accredited by NCQA, we underwent a survey and met certain standards designed to evaluate our clinical and administrative systems. These standards fall into five broad categories (defined in this brochure) including Access and Service, Qualified Providers, Staying Healthy, Getting Better and Living with Illness. A national oversight committee of physicians assigns one of five possible accreditation levels (excellent, commendable, accredited, provisional, or denied) based on the plan's level of compliance with NCQA standards. Because of our Excellent Accreditation, you can be confident in choosing GVHP as your health plan.

NCQA Categories Defined

Access & Service

NCQA evaluates how well a health plan provides its members with access to needed care and with good customer service. For example: Are there enough primary care doctors and specialists to serve the number of people in the plan? Do patients report problems getting needed care? How well does the health plan follow up on grievances? To evaluate these activities, NCQA reviews appeals and health plan denials records, interviews health plan staff and grades the results from consumer surveys.

Qualified Providers

NCQA evaluates health plan activities that ensure each doctor is licensed and trained to practice medicine and that the health plan's members are happy with their doctors. For example: Does the health plan check whether physicians have had sanctions or lawsuits against them? How do health plan members rate their personal doctors or nurses? To evaluate these activities, NCQA uses records of doctors' credentials, interviews health plan staff and grades the results from consumer surveys.

Staying Healthy

NCQA evaluates health plan activities that help people maintain good health and avoid illness. For example: Does the health plan give its doctors guidelines about how to provide appropriate preventive health services? Are members receiving tests and screenings as appropriate? To evaluate these activities, NCQA reviews health plan records, grades independently verified clinical data and reviews materials sent to members.

Getting Better

NCQA evaluates health plan activities that help people recover from illness. For example: How does the health plan evaluate new medical procedures, drugs and devices to ensure that patients have access to the most up-to-date care? Do doctors in the health plan advise smokers to quit? To evaluate these activities, NCQA reviews health plan records and interviews health plan staff.

Living with Illness

NCQA evaluates health plan activities that help people manage chronic illness. For example: Does the plan have programs in place to assist patients in managing chronic conditions like asthma? Do diabetics, who are at risk for blindness, receive eye exams as needed? NCQA grades independently verified clinical data and interviews health plan staff.

The NCQA Home Page can be found at:http://www.ncqa.org/