NCQA releases draft for DM accreditation

Health systems turning to DM in quality efforts

The National Committee for Quality Assurance (NCQA) in Washington, DC, has released for public comment its draft standards for the accreditation and certification of disease management programs. Peer review professionals may find the standards of interest because many health plans and leading employers contract with disease management vendors to provide focused assistance to patients with specific illnesses and conditions.

Margaret E. O’Kane, NCQA president, says the committee will issue its final requirements by the end of the year. Surveys will begin in January 2002. "Disease management programs can substantially improve care for the sickest patients," O’Kane says. "Through planning, outreach, education, coordination, and tracking, we’ve seen how focused disease management efforts can help ensure that people get the right care at the right time."

Disease management programs identify patients with chronic conditions or other ongoing health care needs and provide them and their doctors with the tools to improve health outcomes. The programs support patients in better managing their health, maximizing their quality of life, and preventing complications.

Members of the Washington, DC-based Disease Management Association of America (DMAA) were among those who helped develop the program, says Richard Vance, MD, senior vice president and chief medical officer of CorSolutions in Buffalo Grove, IL, and chair of the DMAA Accreditation Committee. "The DMAA believes the industry has matured to the point where adopting standardized accreditation is a critical next step," he says. "It will help show the value of quality disease management initiatives. NCQA has been extremely proactive and inclusive in developing the program so far."

Typical disease management tools used with patients include telephone contact with nurses for coaching and reminders about staying on a treatment plan, biometric devices for home monitoring of conditions such as high blood pressure and diabetes, and patient information that might be printed or placed on the Internet. For physicians, typical tools include clinical guidelines and reminders about their patients’ needs for check-ups and testing. Disease management relies heavily on information systems to identify and track patient progress and to produce data on clinical performance.

The health care system increasingly is turning to disease management as part of the solution to its quality challenges, says Rhonda Robinson-Beale, MD, executive medical director of medical and care management programs for Blue Cross Blue Shield of Michigan. "NCQA accreditation and certification of these programs will help point health plans and others to the best disease management vendors," she says.

Many different types of organizations will be eligible to participate in NCQA’s disease management programs. Although most participants likely will be freestanding disease management organizations contracting with a managed care organization or employer, other organizations providing disease management services — including behavioral health care organizations, medical groups, and others — are expected to participate as well.

Health plans and other organizations contracting with NCQA-accredited or certified disease management programs will receive automatic credit on related quality improvement standards that they otherwise would be required to satisfy.

NCQA will offer disease management organizations two types of review. Accreditation is designed for comprehensive programs that address a full range of functional areas in disease management, including patient self-management services, practitioner support, program content, clinical systems, coordinating care, and measuring clinical performance. Certification, on the other hand, focuses just on one or more of those functional areas.