Accreditation to Approve Health Plans and Providers

The 2010 federal Affordable Care Act (ACA) calls for use of accreditation to ensure quality in the managed health care sector and provide resources to state policy-makers through public-private partnerships.

“Accreditation” is a comprehensive evaluation process in which a health care organization’s systems, processes, and performance are examined by an impartial external organization (“accrediting body”) to ensure that it is conducting business in a manner that meets redetermined criteria and is consistent with national standards.

More than 45 states currently use accreditation of a variety of health care organizations as part of their overall strategy to evaluate—and at times improve—the quality and cost-effectiveness of care and to promote compliance with state laws.