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DM Programs Evaluation Options

Because NCQA’s DM accreditation and certification programs evaluate functions, rather than specific types of organizations, these programs are open to a wide variety of organizations. Eligible entities include (but are not limited to) DM organizations, health plans, MBHOs, pharmaceutical companies, provider organizations, PBMs, medical groups, and population health management organizations.

Accreditation Options

Organizations eligible for DM accreditation take responsibility for developing content and systems and for operating DM programs. Organizations may bring as many programs or conditions forward for accreditation as they wish. There are two evaluation options.

Patient and practitioner oriented: This is the most comprehensive option as it includes 32 standards and is for organizations that work with both patients and practitioners. It conveys the most automatic credit to health plans and MBHOs that contract with an accredited DM program.

Patient oriented: This option is directed to comprehensive programs that address all interventions toward patients and do not have regular contact with practitioners.

Certification Options

Certification products represent subsets of the DM standards that are appropriate for organizations that provide specific services but not comprehensive programs. As in accreditation, organizations applying for certification may bring forward as many programs as they wish. NCQA offers two types of certification for those specialty services.

Program design: This option includes development of DM content according to clinical guidelines and may incorporate printed, electronic, telephone and in-person methods for working with patients and practitioners. It does not include implementation.

Systems:  This option includes design of clinical information systems to support DM. It does not include implementation.

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DM Report Card


View the Disease Management Accreditation and Certification Report Card.

 

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HEDIS Users Group (HUG)
HUG membership packages offer you access to the most up-to-date information on HEDIS specifications so you can begin planning for the future.

HEDIS and ICD-10
To accommodate the switch from ICD-9-CM to ICD-10, NCQA created a plan to identify a valid and appropriate set of ICD-10 codes for each HEDIS measure.

Interactive Review Tool (IRT)
Learn more about the IRT Web-based Survey Platform.

Disease Management Resources

Education Seminars