New Case Management Accreditation Raises the Bar in Care Coordination Evaluation
Three early adopters are first to seek NCQA Accreditation

WASHINGTON, D.C. — Today the National Committee for Quality Assurance (NCQA) released its new Case Management (CM) Accreditation program for organizations managing care for patients with complex health care and social needs. Already, three organizations will be the first to seek NCQA accreditation: Alere (www.alere.com), Monroe Plan for Medical Care (www.monroeplan.com) and OptumHealth Care Solutions(www.optumhealth.com).

Designed for case management programs in provider, payer or community-based organizations, NCQA’s CM Accreditation ensures that patients with complex conditions receive effective, coordinated patient-centered services that lead to good outcomes. In becoming an NCQA-Accredited Case Management program, organizations make a clear statement that they are dedicated to providing personalized effective care - not just checking a box for another distinction.

NCQA’s Case Management Accreditation: 

  • Addresses how organizations deliver case management services—not just how they handle internal administrative processes.
  • Emphasizes care coordination, patient-centeredness, quality of care and getting the right care to patients.
  • Encompasses a wide variety of organizations (i.e. standalone case management vendors, health plans, managed behavioral health organizations, community care teams and others). CM Accreditation can be used to align goals and approaches to case management across payers and providers.
     

Additionally, it is the only program that assesses quality during a patient’s transition between care settings.  As patients’ health needs often fall through the cracks when they move from one setting to the next, effective case management can ensure continuity of critical services as patients travel through the system.

“Case Management Accreditation moves us closer to measuring quality across population health management initiatives,” said Margaret E. O’Kane, President, NCQA. “Not only does it add value to existing quality improvement efforts; it also demonstrates an organization’s commitment to the highest degree of improving the quality of their patients’ care.” 

“Alere is delighted for the opportunity to become one of the first-adopters of NCQA’s Case Management Accreditation,” said Scott Schell, Executive Vice President and Chief Clinical Officer, Alere. “Holistic case management solutions represent the ideal platform for optimally managing increasing complexities in patient care, multiple co-morbidities, complicating social and financial challenges, and multiple sites and providers of care delivery. Together these changes underscore the need for systematic evaluation of program effectiveness and expanded accreditation standards.” 

Joseph A. Stankaitis, Chief Medical Officer, Monroe Plan for Medical Care and NCQA Review Oversight Committee member noted“With the Affordable Care Act driving monumental changes in the healthcare delivery arena, Monroe Plan believes that achieving NCQA accreditation for case management would provide a greater degree of assurance for its regulators, partners, practices and communities by demonstrating that Monroe Plan has what it takes to provide optimal person-centered care.” 

“OptumHealth Care Solutions Inc. is excited to be an early adopter of the Case Management Accreditation program. It is an opportunity to continue to showcase our commitment to the highest in quality standards,” explained Margaux Frazee, Director of Enterprise Audit and Accreditation for Optum Health Care Solutions, Inc.

Current NCQA-Accredited health plans or accountable care organizations and NCQA-Recognized patient-centered medical homes are eligible for automatic credit when they work with an NCQA-Accredited CM organization. Organizations can apply for accreditation and receive a three-year or two-year accreditation status based on performance against the standards.

Learn more about NCQA’s Case Management Accreditation program.

ABOUT NCQA

NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care. NCQA is committed to providing health care quality information for consumers, purchasers, health care providers and researchers.

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