NCQA Accreditation for Case Management

 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. 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. 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.

Required Standards for NCQA Case-Management Accreditation

    • Program Description

      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.

    • Care Planning

      Coordinates services for patients through the development of individualized care plans.

    • Care Monitoring

      Has systems in place to support case-management activities and monitors individualized care plans.

    • Care Transitions

      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.

    • Delegation

      Provides written documentation of each delegated arrangement.