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NCQA Standards: An Opportunity to Lead

Special Report by Carol Alter, MD, FAPM

PDF icon NCQA Standards (complete document)

The National Committee on Quality Assurance (NCQA), which surveys and accredits 60% of all managed care organizations which cover 85% of all insured lives in this country, has released a new set of standards which address the coordination of medical and psychiatric care. It specifically calls on all medical and behavioral managed care plans to have mechanisms in place to maximize coordination of care between systems and to meet specific clinical standards in the care of depression. These new standards represent an important opportunity for psychiatrists to provide expertise to managed care organizations in order to help them meet these standards. The NCQA Standards outline the obligation for both the managed behavioral health organization carve-out and the general medical plan to coordinate mental health care. The standards can be downloaded by clicking the link at the end of this article.

The NCQA Accreditation '99 plan has also increased its mission to include the incorporation of Health and Employer Data and Information Set (HEDIS) measures into the accreditation process. HEDIS measures include clinical outcomes, process outcomes, and patient satisfaction outcomes. In 1999, HEDIS will introduce the first indicator specifically relevant to outpatient mental health practice that will focus on the clinical management of antidepressant treatment. The measure will be used in both medical and mental health settings. The indicator aims to measure the adequacy of clinical management of patients who are diagnosed with major depression and who are receiving treatment with an antidepressant. This indicator establishes its rationale through use of the AHCPR Clinical Guideline on Depression in the Primary Care Setting. 1999 will mark the first year where obtaining accreditation status will require reporting and auditing of HEDIS measures.

Action Steps

Concretely, these new standards present an opportunity to develop relationships with medical colleagues and administrators to help to assist them meet these standards.

  • Psychiatrists can become involved with medical groups to discuss: (1) existing mechanisms for referral, (2) development of integration strategies, (3) their participation in the training of primary care physicians, and (4) the development and implementation of clinical algorithms.

  • Managed care plans will be significantly at risk for not meeting NCQA accreditation if they cannot meet these standards. Therefore, appropriate financial remuneration should be addressed in any of these discussions.

  • Many plans will call upon social workers, case managers and psychologists to meet these needs.

  • C-L Psychiatrists are ideally positioned to drive this process.

This is a clear opportunity for us to present ourselves as the experts in this area. All managed care plans being accredited starting in July 1999 will be required to meet these standards or risk their accreditation standing. Begin working within your practice setting. Contact Carol Alter, MD for more information (calter at tenproject dot org).

PDF icon  NCQA Standards (38 Kb)



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