AUGUST 4, 2005 -- Fifty-seven health plans have agreed to adopt new care management standards for encouraging wellness and prevention among members, the National Committee for Quality Assurance (NCQA) announced this week.
Over the next few months, NCQA, a private non-profit organization that accredits health care organizations, will survey the health plans to assess their efforts in prevention, disease management, and complex case management.
NCQA president Margaret E. O'Kane expects most health plans will act on the ideas behind the standards in five years. The program is designed to encourage NCQA-accredited plans to achieve additional distinction as "early adopters" of the new standards before they become mandatory.
To meet the new standards, plans might recruit smokers into smoking-cessation programs or remind members who have missed routine screenings, according to NCQA.
Industry leaders predicted savings as a result of meeting the standards. Helen Darling, president of the National Business Group on Health, said in a press release that improved health care management of chronic illnesses "results in fewer sick days, fewer hospital stays, lower medical costs and...improved productivity and quality of life."
The NCQA survey also will assess the effectiveness of plans' "case management" programs, which help individuals with chronic or complex conditions determine the best course of treatment, by scrutinizing referral systems and rates of hospital readmissions and emergency room visits.
The surveys for the Care Management and Health Improvement standards, the second installment of the Quality Plus program, are set to begin Oct. 1. The first decisions will be announced during the first half of 2006.
The first part of NCQA's Quality Plus program, Member Connections, focused on how health plans used their Web sites to provide health, pharmacy, and claims information. The third set of standards, Physician and Hospital Quality, is set to launch in 2007.