News Briefs: NCQA releases its final standards for DM programs

The National Committee for Quality Assurance (NCQA) in Washington, DC, today announced the release of final standards for its Disease Management (DM) Accreditation and Certification programs. The programs, the first targeting the wide variety of organizations providing disease management, have drawn extensive support from industry leaders. Even prior to their release, 20 organizations of various types already have committed to reviews. The health care industry increasingly is looking to focused disease management as a critical part of the solution to health care costs that are again on the rise.

"NCQA’s new disease management programs are designed to ensure that the enormous promise of disease management is fulfilled," says NCQA President Margaret E. O’Kane. "Accreditation and certification will give health plans and employers an indication of which organizations have what it takes to take better care of the chronically ill."

"The rapid proliferation of organizations offering disease management services has led to confusion in the market," says David B. Nash, MD, MBA, associate dean, Jefferson Medical College in Philadelphia. "NCQA is the right organization to help identify those DM organizations that can deliver better health outcomes for the seriously or chronically ill."

Managed care organizations (MCOs), managed behavioral health care organizations, and preferred provider organizations (PPOs) contracting with accredited or certified DM organizations will receive automatic credit for parts of the most rigorous NCQA quality improvement standards, thus facilitating their own accreditation efforts. Organizations electing to achieve DM Accreditation themselves will also receive credit on these standards.

Employers, whose backing encouraged the growth of NCQA’s accreditation programs for MCOs and PPOs, are demonstrating support for DM Accreditation and Certification.

NCQA will deliver the DM Accreditation and Certification programs in a newly redesigned, web-based review process that emphasizes efficiency. The updated process shifts much of the review to electronic formats, focusing on increased use of the Internet and the advanced data capabilities of participating organizations. It also minimizes the on-site review portion of a survey, thus reducing costs and increasing efficiency.

To meet the needs of a diverse range of potential participants, NCQA has devised a number of different accreditation and certification review options. They are:

Accreditation Options

  • Patient and Practitioner Oriented Accreditation is the most comprehensive review option. It includes 32 standards. This option is designed for organizations that work with both patients and practitioners, and conveys the most automatic credit to health plans that contract with an accredited DM program.
  • Patient Oriented Accreditation is designed for comprehensive DM programs that focus exclusively on patients and do not have regular contact with practitioners.
  • Practitioner Oriented Accreditation is designed for comprehensive DM programs that work through practitioners.

Certification Review Options

NCQA’s DM Certification programs essentially are subsets of the DM standards that are appropriate for organizations that provide specific services such as designing, but not operating DM programs. NCQA offers three types of certification for these organizations:

  • DM Program Design Certification includes a review of DM content — such as printed, electronic, and in-person methods for working with patients and practitioners — according to clinical guidelines.
  • DM Systems Certification reviews the design of clinical information systems, such as those used to identify patients, to support DM.
  • DM Contact Certification addresses patient contact, and covers such areas as patient program information, patient participation, and access to health care professionals.

The 20 organizations that have applied for a DM review represent all of the accreditation and certification options. Eighteen other applicants were announced in December 2001.

The 2002 DM Standards and Guidelines for Accreditation and 2002 DM Standards and Guidelines for Certification are available as printed or electronic publications. To order, or for more information, visit www.ncqa.org or call (888) 275-7585.