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Health plans seek top honors for wellness and prevention, and case management efforts

Case Management Weekly, August 3, 2005

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The National Committee for Quality Assurance (NCQA) recently announced that 57 of the nation's health plans are already putting into practice the accretitor's new Care Management and Health Improvement standards. The standards-which zero in on wellness and prevention efforts, and management of chronic illnesses and complex conditions-are the second batch of standards to be released for the NCQA's Quality Plus program. Within the program, NCQA-accredited health plans try to set themselves apart from others by receiving formal recognition for performing at high levels in certain areas, such as effectively involving members in wellness and prevention programs. According to the new standards, the NCQA also wants to see organizations using many sources for retrieving members' health information in order to best manage their chronic illnesses or complex conditions. The new standards also want to know if specific case management programs exist within health plans, whether referrals are granted to members in need, and whether such case management programs are working at all-which will be determined by reviewing information such as the number of readmissions and emergency room visits. The 57 health plans already implementing NCQA's new standards have volunteered to be surveyed against these yet-to-be-mandatory standards. The surveys are scheduled for October.

For more information, visit http://www.ncqa.org/index.htm.

Source: NCQA's Web site

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