New standards guide DM programs

NCQA seeks to streamline accreditation process

The National Committee for Quality Assurance (NCQA), based in Washington, DC, has released draft standards for the accreditation and certification of disease management (DM) programs. The NCQA accredits and certifies a wide range of health care organizations.

Typical disease management tools include telephone contact with nurses for coaching and reminders about staying on a treatment plan; biometric devices for home monitoring of conditions like high blood pressure and diabetes; and patient information that might be printed or Internet-based.

The two major sources of DM programs are managed care organizations and private DM vendors. Under the new draft standards, which are slated for adoption in final form at the end of the year, programs either will be accredited or certified. "Certification will focus on a specific part of disease management, while accreditation will be more global," explains Linda Shelton, MA, NCQA assistant vice president, product development, and lead individual in the development of the new standards. "For example, pharmaceutical companies develop materials to support DM programs. They would be eligible for certification, since they don’t actually operate a program."

The NCQA has had DM requirements in place for some time for managed care organizations, notes Shelton. "They require at least two DM programs; we also have HEDIS (Health Plan Employer Data and Information Set) measures of good chronic disease care," she notes. "But as we saw this industry developing we felt we should have a separate DM accreditation so we could be most efficient. We like to look at any program or activity only once."

This new move underscores the importance of DM programs to employee health in general, and to occ med professionals in particular — and, of course, to employers.

"Employers are very interested in DM, because people with chronic diseases lose more time from work. About 20% of the insured population accounts for 80% of the health care cost. And there are also productivity issues," notes Shelton.

What does this mean for you?

Shelton would not go as far as to say that DM should be an integral part of an in-house occupational health program. "All places of employment are different," she observes. "Some may include DM as part of a multi-purpose response to health needs, while others might carve out that service to DM organizations. If you define occupational medicine as taking care of problems on the job or dealing with injuries that are the result of job activities, then there is not an overlap with DM. If you define it as helping employees with any of their medical problems, then it definitely does."

At its core, DM helps the employee to manage his or her chronic condition, notes Shelton. "It involves offering assistance with the part of health care that used to exclusively be the patient’s responsibility," she explains.

"It used to be that the doctor would say, Quit smoking,’ or Go on a diet, and see me in three months.’ Then, it became a case of out of sight, out of mind. DM recognizes that doing all of these things is hard; it means you have to change your behavior every day, many times a day. A lot of people need more assistance than just a word of advice; they need know-how about changing their diet, and all kinds of motivational assistance to quit smoking. They probably need reminders about complicated medical regimens, and when to get back to the doctor. With the recent increased exposure about diabetes, everyone has become more attuned to the impact of chronic diseases."

The draft standards were released for public comment this summer. When will organizations be able to receive their reviews? "As soon as the final standards are ready we will be ready," says Shelton.

[For more information, contact:

• Linda Shelton, MA, assistant vice president, product development, NCQA, 2000 L St., N.W., Suite 500, Washington, DC 20036. Telephone: (202) 955-3500. Fax: (202) 955-3599. Web: www.ncqa.org. E-mail: dmcert@ncqa.org, or Shelton@ncqa.org.

• Disease Management Association of America. Warren Todd, president. Telephone: (202) 861-1491. Web: www.dmaa.org.]