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, MCOs, pharmaceutical companies, PPOs, provider organizations, PBMs, medical groups, and nurse call centers.

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 three evaluation options.

Patient and practitioner oriented: The most comprehensive option, it includes 32 standards and is for organizations that work with both patients and practitioners. It conveys the most automatic credit to MCOs 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.

Practitioner oriented: The third accreditation option is directed at those comprehensive programs that work through practitioners but do not have regular contact with patients.

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 three 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.

Contact:  This option covers implementation but not program design or systems certification, and is appropriate for organizations such as call centers that may be contracted to perform some DM services according to other organizations’ program design.