Case Study: The National Committee for Quality Assurance achieves NCQA Health Plan Accreditation readiness with Optum

The National Committee for Quality Assurance - Customer Case study

The National Committee for Quality Assurance’s (NCQA) Health Plan Accreditation (HPA) is the industry benchmark for clinical performance and consumer experience, and one mid‑size payer facing NCQA re‑accreditation had only months to prepare across three lines of business amid staff turnover and COVID‑19 disruptions. That payer turned to Optum for consulting services to help rapidly assess readiness and compile the required documentation to meet updated NCQA standards.

Optum assessed and prioritized existing documentation against NCQA requirements, reviewed two and a half years of materials to cite proof points, identified previously unrecognized projects as valid evidence, trained new staff, and supplied subject matter experts to fill gaps. As a result, the payer achieved NCQA HPA for all three lines of business, positioning the organization for future accreditation cycles — a clear, measurable win delivered by Optum’s consulting engagement.

The National Committee for Quality Assurance