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Our Care Navigation™ program earns NCQA accreditation, but what does it mean?

We sat down with Peggy Chen, Strategic Initiatives Manager, Care Navigation, to chat about the recent NCQA accreditation of our Care Navigation program.

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We sat down with Peggy Chen, Strategic Initiatives Manager, Care Navigation, to chat about the recent NCQA accreditation of our Care Navigation program, and how Collective Health is paving the way for excellence in complex case management.

What is the National Committee for Quality Assurance (NCQA)?

NCQA is an independent, not-for-profit organization dedicated to assessing and reporting on the quality of managed care plans, managed behavioral healthcare organizations, preferred provider organizations, new health plans, physician organizations, credentials verification organizations, disease management programs and other health-related programs.

What accreditation was granted to Collective Health and what does it entail?

Collective Health has received the NCQA 2-year Case Management Accreditation for our complex case management program, Care Navigation. NCQA Accreditation standards are intended to help organizations achieve the highest level of performance possible, and create an environment of continuous improvement. These standards cover areas like care planning, measurement and quality improvement, and care monitoring, to name a few.

The accreditation provides a framework for implementing evidence-based best practices to ensure efficient and cost-effective case management processes and service delivery, with everything from how we manage members transitioning between care settings to our member-centered assessments to determine care needs.

What steps did Collective Health have to take to become accredited? How long did the process take?

NCQA performed a rigorous review of Care Navigation’s documented workflows, processes, reports and materials, as well as conducted a live survey of randomly selected cases. We kicked off the process in 2020, reviewed the standards and began our survey lookback period starting December 2021.

What is a complex case management program?

Case management is a collaborative process of assessment, care planning, advocacy and care coordination to help members meet their care goals. Complex case management takes it a step even further.

NCQA defines complex case management as: “Programs aimed at patients who have experienced a critical event or diagnosis that requires extensive use of resources and who need help navigating the system to facilitate appropriate delivery of care and services.” Ultimately, complex case management aims to help at-risk or high risk members improve their health outcomes.

How does Care Navigation differ from existing care management programs offered by other companies?

While traditional case management models tend to be focused on nurse-led models, Care Navigation includes a multidisciplinary team of social workers, nurses, pharmacists, dietitians and care coordinators, with a focus on addressing social determinants of health, hence our social worker driven model.

We are also “condition agnostic,” meaning we work with any condition and any part of a member’s journey. We are also uniquely able to not only meet the member where they are in their care journey, but also have insight and transparency into their claims and benefits, making it a seamless experience and a one-stop shop for all the member’s needs.

What are the benefits of receiving accreditation? How will this accreditation help advance Collective Health as a leader in the healthcare and benefits industry?

The biggest benefit of receiving accreditation is the assurance that we are meeting rigorous standards of excellence in operational performance, case management processes and service delivery. Programs that are NCQA accredited also continue to receive support and resources towards continuous improvement in quality of care.

This particular accreditation also serves as an important testament to the hard work and dedication put forth by our Care Navigation team to the members they serve every day.

How does this help Collective Health’s users – the employers as well as the employees/plan members?

Collective Health members who have Care Navigation as a benefit can rest assured that they are receiving the best of the best support from our case management team. They can also know that the program as a whole is working in adherence to a nationally recognized set of standards – from program materials to outcome measurement.

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