TurningPoint Healthcare Solutions Renews NCQA Accreditation for Utilization Management



TurningPoint Healthcare Solutions Renews NCQA Accreditation for Utilization Management

Lake Mary, Fl. – June 28, 2023 – TurningPoint Healthcare Solutions, a leader in clinical and technology-enabled condition management, is pleased to announce a reaccreditation by the National Committee for Quality Assurance (NCQA) for Utilization Management (UM), scoring a 99.35 out of a possible 100 points. Receiving NCQA accreditation for Utilization Management is a testament to TurningPoint’s commitment to better healthcare outcomes for our clients and their members through evidence-based medicine.

Eric Pezzi, CEO of TurningPoint Healthcare Solutions, expressed his pride, stating, "At TurningPoint, we are guided by clinical expertise in everything we do. We are deeply honored to receive this reaccreditation from NCQA, which underscores our commitment to excellence and our unwavering dedication to building a better, patient-centered healthcare experience."

The prior authorization process can be burdensome to healthcare professionals, patients, and families. All too often, critical care is denied or delayed due to poorly designed policies that require authorization for routine things, like medications and lab draws.

TurningPoint approaches prior authorization differently. Musculoskeletal (MSK) and Cardiac conditions make up two of the largest categories of healthcare spend, yet:

      · Nearly 40% of back surgeries fail. 1
      · More than a quarter of total knee replacements are later found to be inappropriate.2
      · In 2020, 1 in 5 coronary stents met criteria for overuse, resulting in more harm than benefit.3

When faced with these costly, complex conditions, prior authorization serves as a collaborative tool to drive towards better medicine. A prior authorization program focused on high-cost surgical events delivers significant clinical and financial impact with only a fraction of the utilization management touches compared to higher volume, lower-value programs. TurningPoint is led by more than 100 board-certified procedural and surgical sub-specialists who deploy proprietary, evidence-based clinical guidelines to ensure the more than 45M members we serve nationwide receive the right care, in the right care setting, at the right time.

As an NCQA-accredited organization, TurningPoint Healthcare Solutions will continue to adhere to the highest industry standards and guidelines in our utilization management practices. This accreditation affirms our dedication to maintaining transparency, accountability, and exceptional service in all aspects of condition management.

Note: NCQA has reviewed and accredited TurningPoint Healthcare Solutions’ Utilization Management functions only. For complete details on the scope of this review, visit www.ncqa.org.

About TurningPoint Healthcare Solutions:

TurningPoint provides an innovative suite of specialty care management services and technologies that enable health plans to improve the safety, quality, and affordability of healthcare. Through its technology platform and specialized team of clinical experts, TurningPoint works collaboratively with providers to enhance the support patients need, at the time they need it most. TurningPoint's comprehensive and integrated suite of services offers condition-specific, quality-driven, value-based care management services that optimize and support members' care from diagnosis and discovery through recovery. TurningPoint provides support for more than 45 million people across numerous clinical conditions, including musculoskeletal (MSK), Cardiology, Wound Care, ENT, sleep, and others. For more information, please visit www.tpshealth.com or follow on LinkedIn.

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[1]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

For media inquiries, please contact:

Rob Costello



1 Failed back surgery syndrome: current perspectives - PMC (nih.gov)

2 One-third of knee replacements in the U.S. may be inappropriate | Reuter

3 Hospital Overuse in Covid - Lown Institute Hospital Index (lownhospitalsindex.org)

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