The standards are organized into the following six categories.

Program Content (CO)

Program content includes all of the information that the DM organization provides to patients and practitioners and how it is presented. Program content 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
• developing patient information that assists with self-management
• developing practitioner information about current guidelines and how program recommendations relate to guidelines and cited evidence
• testing content usefulness with consumers or ensuring that the content source has tested it

Patient Service (PT) 

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

• enlisting and measuring the 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
• acting as a patient advocate
• providing feedback to patients about their progress toward treatment goals
• encouraging patient and practitioner communication.

Practitioner Service (PR)

The organization works with practitioners, either through a supplemental program or within an integrated delivery system. Practitioner services principles include:

• supporting practitioner decisions with evidence-based recommendations on care of chronic conditions and reminders and feedback to patients about their progress
• providing practitioner feedback on the condition and progress of their patients
• stating a commitment to practitioner rights and encouraging practitioners to work with the program to coordinate patient care.

Clinical Systems (SY)

Most DM programs utilize specialized clinical software to identify and stratify eligible patients; track actions, interventions and patient progress and measure success. NCQA specifies functions to be performed rather than specific requirements for information systems. Those functions are:

• using available clinical data from the sponsoring organization or from eligible participants to identify potential participants and stratify them for assignment to different levels of service intensity
• coordinating information for all parts of the system (from patients, sponsoring organizations, the disease management organization and practitioners) to promote better self-management
• using organization information to address patient safety issues
• protecting the privacy of patient information.

Measurement and Quality Improvement (MQ) 

The DM accreditation and certification programs are designed to impose principles of good measurement that include:

• measuring quality across the organization and for each condition managed
• including all identified possible/eligible participants as the population measured
• using evaluative patient and practitioner data to assess experience with the DM program for quality improvement
• analyzing performance data and taking action for quality improvement.

Program Operations (OP) 

The organization works to support and maintain appropriate operational aspects of the DM program. 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 and giving them the necessary training and specifying the qualifications of personnel who give clinical information to patients
• disclosing any business relationships and marketing activities
• responding appropriately to patient and practitioner complaints.