MANAGED CARE August 2005. ©MediMedia USA
Nearly 60 health plans have signed on as "early adopters" of the care management and health improvement standards newly updated by the National Committee for Quality Assurance. They are part of NCQA's Quality Plus Program, which allows NCQA-accredited plans to pursue additional distinction in selected areas by meeting tough new standards even before they become mandatory.
"In five years, most health plans will engage in the kinds of activities that we're looking for with these new standards," says NCQA President Margaret E. O'Kane. "But if you're selecting a health plan tomorrow, you really want to know which plans are taking steps now to prevent and manage chronic condtions.
Health plans that excel at engaging members in wellness and prevention programs will do well. These plans might identify and recruit smokers into smoking-cessation programs or send out reminders to members who missed routine screenings.
The new standards also look at how well an organization uses resources to identify and manage patients with chronic illnesses or complex conditions. The standards ask not only whether these "case management" programs exist, but also how effectively members who might benefit are referred to the programs.