Our Quality Improvement Accomplishments

Neighborhood is one of the highest-rated health insurance plans in the nation by the National Committee for Quality Assurance; NCQA’s Medicaid Health Insurance Plan Ratings 2015-2018.

NCQA Accreditation

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Neighborhood Health Plan of Rhode Island (Neighborhood) is fully accredited with the National Committee for Quality Assurance (NCQA). NCQA is an independent, non-profit organization whose mission is to improve health care quality.

NCQA Accreditation is a nationally recognized evaluation that purchasers, regulators, and consumers can use to assess managed care plans. NCQA Accreditation evaluates how well a health plan manages all parts of its delivery system – physicians, hospitals, other providers and administrative services – in order to continuously improve health care for its members. NCQA accreditation surveys include rigorous on-site and off-site evaluations of over 60 standards and selected HEDIS® performance measures.

These standards include the following categories:

• Quality Improvement and Management
• Network Management
• Utilization Management
• Credentialing and Recredentialing
• Members’ Rights and Responsibilities
• Member Connections
• NEW: Population Health Management

A team of physicians and managed care experts conducts accreditation surveys. A national oversight committee of physicians analyzes the team’s findings and assigns an accreditation level based on the performance level of each plan being evaluated according to NCQA’s standards.

Neighborhood first earned NCQA’s “Excellent” Accreditation status in 2001 for its Medicaid product and has retained that through every subsequent accreditation cycle. NCQA’s “Excellent” Accreditation status is reserved for the best health plans in the nation. It is only awarded to those plans that meet or exceed NCQA’s rigorous requirements for consumer protection and quality improvement and deliver excellent clinical care. In 2014, Neighborhood attained “Accredited” status for its Marketplace product line, the highest status available for Marketplace.

Neighborhood NCQA Accreditation Results (Medicaid)

Neighborhood Accreditation Results (Marketplace)

To learn more about NCQA, please visit the NCQA website at www.ncqa.org.

Ratings are based on the National Committee for Quality Assurance 2015-2018 Health Insurance Plan Ratings.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).