Managed Care


NCQA To Accredit DM Programs, HEDIS Software

MANAGED CARE July 2000. © MediMedia USA
News and Commentary

NCQA To Accredit DM Programs, HEDIS Software

MANAGED CARE July 2000. ©2000 MediMedia USA

The National Committee for Quality Assurance will soon offer its blessing to disease management programs. NCQA is developing a DM certification program intended to recognize regimens that effectively manage chronic illnesses. The program will go live next year.

Stand-alone DM vendors will be eligible for certification, as will in-house DM programs at health plans. Though NCQA is the second organization to enter the field of DM evaluation, it may be first to the finish line. The Disease Management Association of America, a DM trade group, has been discussing a DM accreditation program since its inception early last year; while no program has evolved, DMAA has issued "standards of care." DM vendors are split over whether accreditation is a necessity, and what it means in expense and administrative burden.

Meanwhile, NCQA is moving forward with two other initiatives. One will encourage makers of HEDIS-related software to vie for its approval. The plan is to certify private vendors' HEDIS-compliance software that correctly handles NCQA-supplied test cases. The certification program is to begin next year.

NCQA's other new venture tries to nudge health plans into doing what they can to make the practice of medicine safer. Beginning next year, NCQA will require plans that seek accreditation to show that they are using care-management expertise to address such issues as adverse drug interactions and coordination of care. Such a system would, in essence, require plans to work more closely with their hospitals and physicians.


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