Disease management accreditation: quality improvement in a new health care environment.

Abstract

THE GOALS OF disease management (DM)— managing health conditions, lessening severity of a disease, and prolonging a quality lifestyle—have always been essential values of the National Committee for Quality Assurance (NCQA). Today’s DM standards of care are a direct outgrowth of standards traditionally developed for managed care organizations. NCQAaccredited MCOs (managed care organizations) cover three-quarters of the Americans enrolled in MCOs. The DM industry itself is less than 10 years old, but many of the diverse organizations that constitute the market want external validation to enhance their image with health plans and employers who purchase their services. For those DM programs that contract with managed care organizations—and most do— NCQA DM accreditation also offers automatic credit towards applicable managed care organization accreditation standards. Currently, there are some 150 programs or services that call themselves DM organizations. The field includes data systems to help manage program operations as well as comprehensive services for management of serious longterm diabetes. To meet this task, NCQA has developed two types of outside validation. Three-year accreditation is available for organizations that offer comprehensive DM programs with services to patients, practitioners, or both. Two-year certification is available to organizations that provide specific DM functions.