Expanded Health Education roles in Managed Care: Relationships between CHES, HEDIS®, and NCQA

Abstract

Prevention-based activities and other Certified Health Education Specialist (CHES) skills are currently in demand in managed care organizations. An important set of roles for managed care that requires select health education skills continues to emerge through the National Committee for Quality Assurance (NCQA) and the Health Plan Employer Data and Information Set® (HEDIS®). This article identifies expanded roles for health educators in managed care organizations by comparing CHES responsibilities to HEDIS® and NCQA standards. The responsibilities for CHES in relation to both HEDIS® and NCQA are complementary. These health education functions within managed care are clearly associated to the responsibilities of certified health education specialists and quality assurance managers. To increase marketability and collaboration with clinical staff, professional health educators must be trained to perform key health education functions that relate to the practice roles of managed care organizations. Specific recommendations for professional preparation and professional practice are discussed.