July 11, 2005

NCQA Updates Disease Management Standards; Public Comment Through August 10

WASHINGTON —The National Committee for Quality Assurance (NCQA) today released for public comment proposed changes to its Disease Management (DM) Accreditation and Certification programs. The changes address selected areas of the programs, including strengthening patient privacy and confidentiality requirements and introducing requirements related to how DM programs identify eligible patients. Also proposed is changing the scoring methodology to make it more consistent with other NCQA Accreditation programs.

Among the proposed changes:

• Use of specific data sources, such as claims data, lab results or health risk appraisal results, to identify patients eligible for DM programs. Programs will also be assessed for how frequently they survey such data sources for eligible members.
• New requirements regarding confidentiality and sharing of patient information with client organizations. These changes relate to compliance with provisions in the Health Insurance Portability and Accountability Act (HIPAA) and standards in other NCQA Accreditation programs, notably Quality Plus.
• The introduction of quality improvement measurement standards that will require DM organizations to annually assess their performance and identify areas for quality improvement.

NCQA’s DM Accreditation and Certification programs are flexible—a wide variety of entities beyond stand-alone disease management organizations are eligible for DM Accreditation or Certification, including medical groups, managed care organizations, preferred provider organizations, pharmacy benefits managers and nurse call centers.

The proposed changes to DM standards can be downloaded from NCQA’s Web site at www.ncqa.org.  Those who wish to comment on the new measures may do so by sending an e-mail to DM2006@ncqa.org.  The final revised standards for NCQA’s Disease Management program will be published in November and will go into effect on July 1, 2006 .

NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations, recognizes physicians and physician groups in key clinical areas and manages the evolution of HEDIS, the tool the nation’s health plans use to measure and report on their performance. NCQA is committed to providing health care quality information through the Web, media and data licensing agreements in order to help consumers, employers and others make more informed health care choices.