NCQA is governed by a Board of Directors that includes employers, consumer and labor representatives, health plans, quality experts, policy makers and representatives from organized medicine.
ODS policy to encourage appropriate utilization and discourage underutilization of services
When making decisions on the appropriateness, medical need and efficiency of healthcare services, ODS bases its decisions only on the appropriateness of the care and service and on existing coverage. ODS does not specifically reward providers or other individuals for denying care. Financial incentives for utilization management decision-makers do not encourage decisions that result in underutilization.