To evaluate how the health plan helps its members to get better when they are sick, NCQA reviews health plan records and interviews health plan staff. NCQA looks for:

• the percentage of adults who smoke and were advised by their doctor to quit.

• a well-defined program for improving the quality of clinical care and service provided to plan members.

• individuals in the health plan responsible for overseeing quality improvement programs.

• distribution of guidelines that assist doctors with providing the right care to plan members with acute conditions.

• evidence of monitoring the quality of care provided to plan members with specific acute conditions.

• evidence that the health plan is working to improve the quality of care provided to plan members with specific acute conditions and correcting any problems of poor quality.

• actual improvements that the plan has made in care and service.

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