The standards are organized into the following seven categories:

Evidence-Based Programs (EB)

The organization uses the best clinical evidence to develop program content. Evidence-based programs principles include:

• Using evidence-based guidelines or standards of care in developing program content for patients and practitioners
• Ensuring that all content is consistent with adopted guidelines
• Ensuring appropriate practitioner oversight of programs.

Patient Services (PT)

The organization works with the patient to encourage self-management behavior that enables good outcomes. Patient service principles include:

• Using available clinical data from the client organization or from eligible participants to identify potential participants and stratify them for assignment to different levels of service intensity
• Integrating relevant patient data to produce actionable patient-level information
• Enlisting and measuring active participation of eligible patients
• Supporting patient self-management with consumer-tested information, coaching, reminders and referrals 
• Stating a commitment to patient rights, including the right to opt out of the program, and expectations of patient responsibilities 
• Encouraging patient and practitioner communication.

Practitioner Services (PR)

The organization supports the practitioner’s plan of care by providing actionable and timely information on their patients’ conditions. Practitioner services principles include:

• Supporting practitioner decisions with evidence-based recommendations on care of chronic conditions 
• Providing practitioners with feedback on care opportunities that must be addressed
  • stating a commitment to practitioner rights and encouraging practitioners to work with the program to coordinate patient care.

Care Coordination (CC)

The organization makes information about patients’ care plans accessible to patients and practitioners. Care coordination principles include:

• Giving patients information about their progress toward treatment goals
• Giving practitioners information about the condition and progress of their patients
• Coordinating referrals and providing relevant information to case management programs and other health resources

Measurement and Quality Improvement (MQ)

Standards are designed to impose principles of good measurement that include:

• Measuring quality across the organization and for each condition managed
• Including all identified possible and eligible participants as the population measured
• Using evaluative patient and practitioner data to assess experience with the DM program for quality improvement
• Measuring cost or efficiency across each program
• Analyzing performance data, taking action for quality improvement and demonstrating improvement in performance

Program Operations (OP)

Supporting and maintaining the operational aspects of the DM program are important to its success. The principles of program operations include:

• Ensuring convenient access to the organization for patients and practitioners
• Providing for patients with special needs
• Employing qualified personnel, giving them the necessary training and specifying the qualifications of personnel who give clinical information to patients
• Disclosing marketing activities
• Responding appropriately to patient and practitioner complaints
• Using available information to address patient safety issues
• Protecting the privacy of patient information.

Performance Measurement

The organization regularly assesses its performance against a standardized, evidence-based set of measures. Organizations that meet this standard receive the designation of Accredited With Performance Reporting.