Caradigm Population Health Solutions Support Care Coordination Institute’s 3-Year NCQA Case Management Accreditation


Post by Cindy Friend, RN, BSN, MSN, MBA/HCA


Vice President of Clinical Population Health Solutions & Transformation

The Care Coordination Institute (CCI), based in Greenville, SC, was awarded a three-year Case Management Accreditation from the National Committee for Quality Assurance (NCQA). To achieve accreditation, CCI passed NCQA’s rigorous and comprehensive independent review of their policies, procedures and the Caradigm Care Management software that CCI uses to support their care management program. This accreditation demonstrates CCI’s commitment to providing the highest level of care for the patients they serve.[1],[2] Not only did CCI achieve the highest level of accreditation from NCQA, they did so in notable time. CCI and Caradigm attribute this success to the preparation and collaboration of their respective teams.

The Accreditation Preparation Process

The NCQA Case Management Accreditation evaluates policies, procedures, and systems that define and support the applicant organization’s care management programs. CCI had to demonstrate their ability to:

  • Evaluate and identify care needs
  • Assess and manage patient interactions
  • Track and report on the outcomes of patient populations

Preparing for the NCQA site visit was no simple feat and was almost a year in the making. CCI submitted their application to NCQA in March 2017. CCI began an intensive gap analysis of their current practices, and refined their policies and processes to address accreditation requirements.

Simultaneously, the Caradigm team evaluated the NCQA Case Management Accreditation requirements related to the population health management system and discovered that half of the accreditation points are attributed to the use of technology. The requirements to assess the population, document care management, and track and report outcomes are supported by Caradigm applications, with most covered by Caradigm Care Management. To support the application process, Caradigm provided CCI with a comprehensive crosswalk document detailing how the Caradigm applications support the various NCQA Case Management Accreditation requirements.

On October 10, 2017, CCI submitted their policies, procedures and other documentation to NCQA as required. They completed two preliminary calls with the NCQA by the end of November, and performed the chart review for a six-month look-back period from April to October 2017.

“The Caradigm Care Management software was one of the key components to our success in demonstrating compliance with the rigorous NCQA Case Management Standards. We appreciate the support the Caradigm team brought to our NCQA survey preparation.”

Nancy Markle, RN
Vice President of Care Transformation, CCI

The Result

The audit component of the NCQA survey went very smoothly. That success is attributed to the collaboration of the CCI and Caradigm teams in ensuring that the care management program and systems incorporate all the key components for optimal population health management.

“The auditor indicated Caradigm assessments included everything required for accreditation.”

Christin Evans, RN
Training & Systems Manager, CCI

In Summary

As healthcare transformation continues to mature, accreditation standards and guidelines will also evolve. A major component of accreditation is the use of population health management solutions since half of the available points for Case Management Accreditation are attributed to technology supported capabilities. Health IT provides the means to efficiently document assessments, automate workflows and generate care plans.

Accreditation organizations require the use of population health solutions to demonstrate that care management organizations are equipped to manage large cohorts of diverse patient populations. This requirement is due to the vast amounts of data maintained in disparate systems that organizations need to aggregate, analyze, measure and report. Maintaining accreditation demonstrates an organization’s competency and proves their compliance with quality standards.

When Frost & Sullivan gave Caradigm the Health IT Leadership Award they noted that Caradigm strives to ensure that its healthcare clients thrive amid the ongoing transformation of the core realm of value-based care (VBC) in the US healthcare marketplace.[3]  Caradigm is committed to developing solutions that lead innovation in population health management and proud to be a partner with CCI in their continued success.

 

[1] National Committee for Quality Assurance.  Care Coordination Institute:  Accreditations, Certifications, & Distinctions Earned by This Organization.  https://reportcards.ncqa.org/#/other-health-care-organization/Other_001G000001U34V3IAJ

[2] Care Coordination Institute.  (2017).  CCI Receives NCQA Case Management Accreditationhttps://new.ccihealth.org/cci-receives-ncqa-case-management-accreditation/

[3] Caradigm.  (2017).  Caradigm Named Recipient of 2017 Frost & Sullivan Product Leadership.   https://www.caradigm.com/en-us/news-and-events/caradigm-named-recipient-of-2017-frost-sullivan-product-leadership-award/