NCQA, the National Committee for Quality Assurance, is an independent nonprofit that measures and rates the quality of healthcare organizations in the United States. Founded in 1990, it evaluates health plans, medical practices, and other healthcare organizations using standardized performance data, then makes that information public so consumers, employers, and government agencies can compare options. Its core tools are accreditation programs, clinical performance measures, and public report cards.
How NCQA Measures Healthcare Quality
NCQA’s most influential product is HEDIS, short for Healthcare Effectiveness Data and Information Set. HEDIS is a standardized set of clinical performance measures that health plans report on every year. These measures track things like how often patients receive recommended cancer screenings, whether people with diabetes get their blood sugar checked regularly, and how well plans manage preventive care for children. Because nearly every major health plan in the country reports HEDIS data using the same definitions, it creates an apples-to-apples comparison that wouldn’t otherwise exist.
Alongside HEDIS, NCQA uses CAHPS (Consumer Assessment of Healthcare Providers and Systems) surveys to capture patient experience. These surveys ask members how satisfied they are with their care, how easy it is to get appointments, and how well their plan communicates. Together, HEDIS clinical data and CAHPS patient experience scores form the backbone of NCQA’s evaluation system.
Accrediting Health Plans
Health plan accreditation is one of NCQA’s highest-profile programs. It evaluates health plans across several categories: quality management and improvement, population health management, network management, utilization management, credentialing, members’ rights and responsibilities, and member connections. Medicaid plans face additional criteria around benefits and services. Plans that go through the process receive a status ranging from “Accredited” to “Provisional” to “Not Accredited.”
What makes NCQA’s accreditation distinct from competitors like URAC is that it’s the only program in the industry that bases results on both clinical performance (HEDIS) and consumer experience (CAHPS). It’s not just checking whether a plan has the right policies on paper. It’s looking at whether patients actually receive recommended care and report positive experiences.
Government and private sector clients also hire NCQA through contracts and grants. Many state Medicaid programs and large employers require or strongly prefer NCQA accreditation when selecting health plans, which gives the accreditation real financial weight in the marketplace.
Rating Health Plans for Consumers
NCQA publishes free online report cards at reportcards.ncqa.org where anyone can look up and compare health plans. You can search by plan name or state and see ratings for commercial, Medicare, Medicaid, and marketplace exchange plans. Each plan receives a rating from 1 to 5 stars based on its combined HEDIS scores, CAHPS scores, and accreditation status.
These ratings evaluate three things: the quality of care patients actually receive, how satisfied patients are with their care, and whether the plan is actively working to improve. If you’re choosing between health plans during open enrollment, these report cards are one of the few places where you can see standardized, independently verified quality data rather than relying on marketing materials.
The Connection to Medicare Star Ratings
If you’ve seen the star ratings on Medicare Advantage plans, those come from CMS (the Centers for Medicare and Medicaid Services), not NCQA. But the two systems overlap significantly. Both use the same 1-to-5 star scale in half-point increments. Both rely on audited HEDIS data and CAHPS survey results. Of the 46 unique measures in Medicare’s Star Ratings, 16 are shared with NCQA’s health plan ratings.
The two systems serve complementary purposes. CMS Star Ratings evaluate Medicare Advantage plans specifically, including pharmacy benefits and program-specific features. NCQA ratings cover a broader range of plan types. Both score plans against national performance thresholds that are updated annually, and neither system will rate a plan if it has too few members to produce statistically reliable results.
Recognizing Medical Practices
Beyond health plans, NCQA runs recognition programs for individual medical practices. The most well-known is Patient-Centered Medical Home (PCMH) recognition, which evaluates primary care practices on how well they coordinate care, communicate with patients, and organize around the patient’s needs rather than around individual office visits. Practices apply through an online survey tool, submit documentation showing they’ve implemented PCMH standards, and renew annually.
PCMH recognition carries real weight in the primary care world. The Health Resources and Services Administration considers the PCMH model foundational for high-quality primary care and sees it as important for improving health equity and addressing social factors that affect health. Many payers offer higher reimbursement rates or bonus payments to PCMH-recognized practices, giving practices a financial incentive to pursue it.
NCQA also runs recognition and accreditation programs for specialty practices, behavioral health organizations, community behavioral health clinics, virtual care providers, case management programs, credentialing organizations, and population health programs.
Data Products and Technology
A less visible but significant part of NCQA’s work involves selling and licensing the data it collects. Products like Quality Compass aggregate HEDIS results across plans, letting researchers, employers, and consultants benchmark performance. NCQA also certifies the technology and processes that health plans use to collect and report quality data, including audit certifications for HEDIS compliance, survey vendor certifications for CAHPS, and prevalidation programs for health information technology.
More recently, NCQA has expanded into digital quality measurement and AI solutions, reflecting the industry’s shift toward electronic health records and automated data extraction. These programs aim to reduce the manual burden of quality reporting while maintaining data integrity.
Why NCQA Matters in Practice
NCQA describes its founding purpose as wanting to “turn on the lights” in healthcare quality. Before standardized measurement existed, there was no reliable way to compare whether one health plan delivered better care than another. NCQA filled that gap by creating common metrics, requiring independent audits, and making results public.
Today, its influence shows up in places most people never notice. When your employer selects which health plans to offer, NCQA accreditation status is often part of that decision. When a state decides which plans can participate in its Medicaid program, NCQA standards frequently set the bar. And when health plans invest in improving screening rates or chronic disease management, they’re often responding to HEDIS measures that directly affect their NCQA scores and public reputation.