Currently, an alternative health MCO may apply for NCQA accreditation for the credentialing of chiropractors under the Physician Organization Certification. Currently, NCQA will not accredit an alternative health MCO for any other important functions such as utilization management or quality management. Two alternative care MCOs have already made significant strides in the accreditation arena. For one, independent accreditation of alternative health MCOs elevates the credibility of alternative care in the medical managed care arena. Again, it is market demand.
Health plans compete for members, and the members are requesting access to alternative health care.
The health plans' discovery that these alternative care MCOs run comprehensive utilization management, quality management, network management, member services and credentialing programs that meet the accrediting organization standards is a resounding positive for the image of alternative health care. If history repeats itself, I suspect that attainment of accreditation will become the new litmus test by which health plans will determine who they will contract with for alternative care benefits. In other words, now that it has been shown that alternative health MCOs can secure accreditation, health plans will begin to demand that the alternative health MCO with whom they contract be accredited. The upside to this is that the alternative health MCOs improve the quality of their programs through the extensive self-assessment they must undergo to undergo an accreditation evaluation. This improvement will be visible primarily through improved utilization review turnaround times, improved MCO staff knowledge when answering your questions and, in some cases, improved grievance and appeal processes.