This article How Faster Healthcare Credentialing Impacts Care Outcomes originally appeared in Future Healthcare Today on October 18, 2024.
Frustration is growing for American healthcare consumers. High cost of care, long wait times for appointments, and inaccessible and depersonalized care all contribute to 73 percent of U.S. adults reporting that the system is failing to meet their needs.
A desire to resolve key consumer issues motivates organizations to evolve outdated legacy processes. The National Committee for Quality Assurance’s (NCQA) recently issued Proposed Standard Updates to 2025 Accreditation Programs outlines new requirements (including shorter provider verification timelines) that can help health systems deliver faster, more accessible care – but only if they embrace technological innovations that allow for a more streamlined credentialing process.
What is the NCQA?
The NCQA is an independent non-profit organization that uses “measurement, transparency, and accountability” to highlight top performing health systems, drive industry improvement, track provider and health plan quality, educate federal lawmakers and regulators responsible for developing policy, and provide accreditation to healthcare organizations within the U.S.
What are the New NCQA Requirements?
NCQA’s Proposed Standard Updates to 2025 Accreditation Programs outlines two major updates to the credentialing process and one optional change for demographic data collection:
- An adjusted timeline of 90 days from 120 days for provider verification from application submission
- Required license monitoring every 30 days
- Optional collection of provider social demographic data (including race, ethnicity, and languages spoken)
How Does this Affect Care Access?
This marks a major shift for healthcare organizations. Accelerating provider verification for different types of clinicians – including physicians, nurses, therapists, dentists, and other skilled specialties – means that consumers frustrated by long wait times and lack of access to necessary care will be able to see providers more quickly. More consistent license monitoring ensures providers remain in good standing and in-network and can help organizations avoid substantial fines due to compliance violations.
Both updates to credentialing requirements can help organizations strengthen consumer loyalty, avoid network leakage, and improve margins. But while both patients and healthcare organizations stand to benefit from a tighter provider verification window, the onus is on organizations to quickly evolve current-state systems and modernize their credentialing process.
What About Collecting Social Demographic Data?
Creating quality care outcomes doesn’t start and end with a provider’s credentials. The option to collect social demographic data on providers, including race, ethnicity, and languages spoken, creates the opportunity to build stronger patient-provider dynamics. While the NCQA’s standard is optional, data is already becoming more available through the Council for Affordable Quality Healthcare (CAQH).
Faster Credentialing in Action
According to a survey by Mental Health America, nearly one in four American adults experienced some form of mental illness in the last year. And while the demand for reliable, accessible mental health support rises, many provider organizations are unable to meet consumer needs; the ratio of one mental health provider for every 340 people in the U.S. means long wait times aren’t just likely but have become the industry standard.
Launched in 2020, Grow Therapy aims to expand access to in-person and virtual mental health support by connecting consumers with in-network providers, while also helping licensed professionals navigate the administrative challenges that come with running a private practice. But long credentialing timelines of 60-to-120 days threatened their ability to make their services widely available and provide quality care to those who needed it most.
By focusing on streamlined interoperability and improving functionality in alignment with NCQA standards and certification, Verifiable made it easier for Grow Therapy to break barriers for consumers across the country.
What providers in all 50 states and more than 50+ insurance companies have noted is that their onboarding timelines dropped to just two weeks, while still onboarding 1,000+ providers every month. Increased access to robust demographic data helps patients choose the perfect provider from the start. And long wait times are a thing of the past: new patients are now able to start seeing a therapist in just three-to-four days – a 95 percent decrease in wait time.
How Can Streamlined Credentialing Improve Care Outcomes for Patients?
Success doesn’t just come from building a network for quality patient care by simply maintaining compliance with NCQA standards. By leveraging quick, accurate, and automated credentialing to innovate and meet evolving consumer needs. The impact is clear; with the right tools at their disposal, healthcare organizations across the country can achieve similar results – and provide patients with quality care.
