Key Differences Between NCQA & URAC Accreditations
Ever wondered whether your organization should pursue NCQA certification or URAC accreditation? In this insightful episode, we break down the complex world of healthcare accreditation with Susan Moore, Founder and CEO of Managed Healthcare Resources, and Lessely Brown-Shuler, former URAC Clinical Accreditation Reviewer. Together, they explore how each accreditation impacts quality, compliance, and organizational growth in healthcare.
Join Susan and Lessely as they unpack the real distinctions between NCQA and URAC accreditation standards, their philosophies, and what it means for your organization’s success.
Inside This Episode:
🗸 The Origins and Mission of NCQA and URAC
🗸 How both organizations were founded in 1990 with different goals for quality oversight
🗸 NCQA’s roots in the HMO Act of 1973, emphasizing evidence-based standards and preventive care
🗸 URAC’s beginnings in Utilization Review, focused on regulatory consistency across states
Program Scope and Offerings
🗸 NCQA’s comprehensive programs: Health Plan, Behavioral Health, Case Management, Credentialing, and Health Equity Accreditation
🗸 URAC’s broader but more segmented approach: Pharmacy, Patient Care Management, Administrative Management, Digital Health, and Health Plan Programs
🗸 Why URAC dominates in Specialty Pharmacy Accreditation while NCQA leads in Health Plan Accreditation
Comparing NCQA vs. URAC Standards and Structures
🗸 NCQA’s process and outcomes focus vs. URAC’s structure and process focus
🗸 The difference in survey frequency and rigor (annual updates for NCQA vs. every three years for URAC)
🗸 Understanding look-back periods, policy requirements, and documentation processes for each accreditor
🗸 The Survey Experience
🗸 NCQA’s off-site survey model with executive review oversight (ROC process)
🗸 URAC’s multi-stage process including desktop review, validation review, and on-site assessment
🗸 Why NCQA surveys are often seen as more rigorous—and why URAC emphasizes education over punishment
Health Equity and Emerging Standards
🗸 How NCQA evolved its Multicultural Healthcare Distinction (2011) into Health Equity Accreditation
🗸 URAC’s introduction of Health Equity Accreditation in 2022 and its growing importance in regulatory alignment
🗸 Choosing the Right Accreditation for Your Organization
🗸 Factors influencing the decision: state mandates, staffing resources, program complexity, and business goals
🗸 Why URAC may be a better fit for newer organizations or smaller entities
🗸 Why NCQA remains the gold standard for organizations focused on outcomes, data analytics, and national recognition
Whether you’re preparing for your first accreditation or re-evaluating your current status, this episode gives you an insider’s roadmap to navigate the decision between NCQA and URAC with confidence.
“We empower healthcare organizations to reach their fullest potential through successful NCQA and URAC accreditation—driving excellence and raising the bar in healthcare quality standards.” — Susan Moore
Contact MHR:
LinkedIn: / managed-healthcare-resources-inc
Website: Managedhealthcareresources.com
Contact us: https://www.managedhealthcareresource...
Email: [email protected]
Schedule a Discovery Call: https://zc.vg/yDwnU
Timestamps
00:00:00 — Introduction and Overview
00:03:00 — The History of NCQA and URAC
00:08:00 — Scope of Programs and Specializations
00:18:00 — Comparing Accreditation Structures
00:30:00 — Health Equity Accreditation Evolution
00:36:00 — Standards, Cadence, and Transparency
00:40:00 — Survey and Review Process Differences
00:52:00 — Post-Survey and Review Oversight
01:00:00 — Which Accreditation Is Right for You?
01:06:00 — How MHR Supports Clients Through AccreditationGet our free resources to assist you with your NCQA or URAC Accreditation Journey:
📌 NCQA v. URAC Get Our Program Comparison Checklist: https://www.managedhealthcareresource...
📌 Understanding URAC Accreditation Programs Guide: https://www.managedhealthcareresource...
📌 How to Hire for Accreditation: Get the DISC Assessment checklist: https://www.managedhealthcareresource...
📌 NCQA Accreditation Publishing/Mailing Case Example Requirements Tool: https://www.managedhealthcareresource...
📌 URAC Pre-application Checklist https://www.managedhealthcareresource...
📌 Choosing an NCQA Consultant Guide: https://www.managedhealthcareresource...