UPMC for You Medicaid Plan Earns Coveted NCQA Health Equity Accreditation & Health Equity Accreditation Plus Designations

Updated on October 8, 2022
Young nurse and female senior in nursing home, measurements are taken or administrative duties taken care of

UPMC Health Plan announced today that its Medicaid managed care plan, UPMC for You, earned Health Equity Accreditation and Health Equity Plus Accreditation status from the National Committee for Quality Assurance (NCQA), which recognized UPMC for You‘s strong commitment to and results related to diversity, inclusion and equity for both its employees and members.

“Earning Health Equity Accreditation and Health Equity Accreditation Plus shows that an organization is making a breakthrough in providing excellent health care to diverse populations. I congratulate any organization that achieves this level of distinction,” said NCQA President Margaret E. O’Kane. “Eliminating racial and ethnic disparities in health care is essential to improving the quality of care overall.”

“Earning these important NCQA designations is continued proof of UPMC Health Plan’s commitment to addressing health disparities across the communities we passionately serve,” said Carrie Whitcher, UPMC Health Plan’s chief quality officer and vice president for Quality Performance. “It also reflects both our ongoing understanding that health plans have a role in addressing health equity and disparity and our holistic commitment to some of our most vulnerable members.”

NCQA’s Health Equity Accreditation evaluates how well an organization has established a standardized framework for continual improvement in health equity efforts. Criteria include the assessment of building an internal culture that supports diversity, equity, and inclusion; collecting data to understand population demographics; offering language services and provider networks that consider individuals’ cultural and linguistic needs; and identifying opportunities to reduce health inequities and improve care.

Through the UPMC Center for High-Value Health Care’s Center for Social Impact at UPMC Health Plan, for example, UPMC Health Plan serves its members and their communities with evidence-based approaches to social needs that impact health, quality and cost. Key areas of focus include workforce development and housing affordability and stability.

NCQA Health Plan Accreditation and Health Plan Ratings
UPMC Health Plan is also NCQA Health Plan Accredited across its Commercial, Medicaid, and Medicare product lines. NCQA Health Plan Accreditation evaluates how well a health plan manages all parts of its delivery system—physicians, hospitals, other providers, and administrative services—to continuously improve the quality of care and services provided to its members.

UPMC Health Plan, Inc., UPMC Health Coverage, and UPMC Benefit Management Services are among the highest-rated commercial HMOs in PA with a rating of 4.5 out of 5 in NCQA’s Commercial Health Plan Ratings 2022. UPMC Benefit Management Services, Inc., is among the highest-rated Commercial PPO/EPOs in the nation and the highest-rated Commercial PPO/EPO in PA with a 4.5 out of 5 for NCQA’s Commercial Health Plan Ratings 2022.

How Plans Are Rated
NCQA accredits and certifies a wide range of health care organizations and manages the evolution of HEDIS®, the performance measurement tool used by more than 90 percent of the nation’s health plans. Health plans are rated in three categories: private/commercial plans in which people enroll through work or on their own; plans that serve Medicare1 beneficiaries in the Medicare Advantage program (not supplemental plans); and plans that serve Medicaid beneficiaries. NCQA ratings are based on three types of quality measures: measures of clinical quality from NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®2); measures of patient experience using the Consumer Assessment of Healthcare Providers and Systems (CAHPS®3); and results from NCQA’s review of a health plan’s health quality processes (NCQA Accreditation). NCQA rates health plans that choose to report measures publicly.

About NCQA
NCQA is a private, nonprofit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care. NCQA’s website (ncqa.org) contains information to help consumers, employers and others make more-informed health care choices. NCQA can be found online at ncqa.org, on Twitter @ncqa, on Facebook at facebook.com/NCQA.org/ and on LinkedIn at linkedin.com/company/ncqa.

1Medicare ratings on approval from CMS.

2The Healthcare Effectiveness Data and Information Set (HEDIS®) is a registered trademark of NCQA.

3CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).###

About UPMC Insurance Services

The UPMC Insurance Services Division serves 4 million members and is owned and operated by UPMC, a world-renowned health care provider and insurer in Pittsburgh, Pennsylvania. The UPMC Insurance Services Division provides commercial products through UPMC Health Plan for both groups and individuals. Its commercial products also include workers’ compensation and employee assistance from nationally known Workpartners®. Government products include Medicare Advantage plans (UPMC for Life); Special Needs Plans for those who are eligible for Medicare and Medical Assistance (UPMC for Life Complete Care and UPMC Community HealthChoices); a Medical Assistance plan (UPMC for You); and Children’s Health Insurance Program plans (UPMC for Kids). Community Care Behavioral Health Organization—one of the nation’s largest nonprofit managed care behavioral health organizations—is also part of the Insurance Services Division. Community Care offers a full range of services to commercial and Medical Assistance members. For more information, visit upmchealthplan.com.

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