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How do provider entities demonstrate their ability to meet regulatory requirements and standards, and how does the process impact safety and/or quality of care?

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Policy Examples

  • Section 1311: Affordable Choice of Health Benefit Plans of the Affordable Care Act (ACA) requires that, beginning in 2014, all health plans offered through state insurance exchanges must adhere to rating systems like Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS), along with a number of other metrics. source
  • The ACA requires all health plans to provide external review processes that include the consumer protections set forth in the National Association of Insurance Commissioners (NAIC) Uniform Health Carrier External Review Model Act (Model Act). source

Outcome Evidence

  • There are over 30 organizations that accredit health care entities in the United States, encompassing all sectors of the health care industry. U.S. accrediting entities for health care providers are the most prevalent (75%), followed by accrediting entities for managed care (16%), and health care technology (9%). source
  • A 2011 systematic review published in Annals of Saudi Medicine concluded there is consistent evidence that shows accreditation programs improve care across multiple clinical conditions. source

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