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Linda Rosenberg

Former President and CEO, National Council for Behavioral Health

Behavioral Health Must Say Yes to Accreditation

February 18, 2014 | Healthcare | Comments
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behavioral health accreditation

I like it when something has more than one use or benefit, whether it’s a kitchen implement, a black suit, or a good idea. As we’ve been thinking about the changes that are underway in healthcare, it occurred to me that the benefits of accreditation are multiplying.

I’ve always worked in behavioral health organizations that had national accreditation and have had the opportunity to see first-hand the benefits — in terms of establishing expectations for staff and management, setting health and safety standards, supporting quality improvement, and providing the community with confidence in the organization. And I know from member organizations that are accredited that most can’t imagine not having accreditation, but for some organizations accreditation is of questionable value.

In an accreditation discussion the question always comes up — if an organization is accredited, will the state authority grant deemed status? Will the state accept national accreditation in lieu of its own inspection process? The discussion more often than not then moves from the issue of deemed status to a discussion of differences between states when it comes to behavioral health policies and regulations. The refrain is — no two states are alike — and accreditation is a uniform set of standards and expected organizational behaviors. Yet as you look from state to state and organization to organization, the issues are the same and the attempted solutions are variations on a few themes

Changing marketplace dynamics necessitate changes in business strategy. And in this increasingly competitive health world, accreditation brings new benefits. Let me explain.  Qualified Health Plans that are being sold through state and federal Marketplaces (we used to call them exchanges) must themselves be accredited by a national accrediting organization and almost all health plans in the commercial and Medicaid space have NCQA accreditation. If your behavioral health organization is considering contracting with a health plan that is accredited by NCQA, having national accreditation could provide you with a competitive advantage.

Here’s why … the NCQA standards for health plans require plans to have a process in place to ensure that staff are properly credentialed to provide services. There is a provision within the standards for provider organizations with external accreditation to be recognized as facilities and to avoid having to credential individual staff members.

On the other hand, when contracting with a provider organization that does not have external accreditation, the health plan is responsible for conducting some type of review to certify that the provider organization has a process for credentialing staff and that requires more work on the part of health plan staff.

So a health plan may never tell you that they require, or even prefer to contract with organizations that are accredited, but there may be differences in the number of referrals that are given, or the size of contracts awarded based on the added complexity of working with organizations that are not accredited.

I’ve always thought accreditation is a good idea and now the benefits are multiplying.  If your organization isn’t accredited, it might be time to rethink your position. Let me know what you think. Post your comments here or contact me.