NCQA Accreditation for Case Management: Access East
In November 2015, the National Committee for Quality Assurance (NCQA), among the nation’s leading health-care accreditation agencies, awarded Access East the NCQA’s prestigious three-year accreditation for intensive case management provided to Medicaid patients. Community Care Plan of Eastern Carolina (CCPEC), Access East’s primary service line, likewise received this important distinction.
Access East is the eastern North Carolina affiliate of the Community Care of North Carolina (CCNC), which serves 1.4 million Medicaid recipients. CCNC itself also received this three-year NCQA accreditation, along with its other 13 state affiliates, the only North Carolina agencies to have hit this top-tier mark; in total, Access East is one of fewer than 30 Case Management organizations nationwide to have achieved this level of NCQA accreditation.
Three-year accreditation is the highest accreditation status NCQA gives in Complex Case Management, recognizing “strong performance” of the functions outlined in NCQA’s case-management standards, as well as dedication to care-coordination, a focus on the primacy of the patient, and continuous quality improvement.
NCQA Case Management Accreditation is the culmination of a nearly three-year voluntary review process for Access East, as well as for CCNC and its other affiliates. NCQA’s high standards (see the 10 benchmarks that follow) encourage case-management organizations to continuously enhance the quality of services they deliver, and NCQA Case Management Accreditation is the only program that focuses on care transition, the management of patients moving between providers or treatment settings.
Case Management Accreditation “demonstrates an organization’s commitment to the highest degree of improving the quality of its patients’ care,” noted NCQA President Margaret E. O’Kane, “We’ve reached excellence,” said Ron Gaskins, Access East Executive Director. “That was our destination.”
Required Standards for NCQA Case-Management Accreditation
Uses up-to-date evidence-based information to develop its case-management program, and regularly updates the program with relevant findings and information.
Patient Identification and Assessment
Systematically identifies patients who qualify for its programs.
Coordinates services for patients through the development of individualized care plans.
Has systems in place to support case-management activities and monitors individualized care plans.
Has a process to manage care transitions, identify problems that could cause care transitions, and prevent unplanned transitions, when possible.
Measurement and Quality Improvement
At least annually, measures patient satisfaction, program effectiveness, and participation rates.
Staffing, Training, and Verification
Defines staffing needs, provides staff with ongoing training and oversight, and verifies health-care staff credentials.
Rights and Responsibilities
Communicates its commitment to the rights of patients and its expectations of patients’ responsibilities.
Privacy, Security and Confidentiality Procedures
Has procedures to protect the privacy of patients’ health information.
Provides written documentation of each delegated arrangement.