Mobile Integrated Healthcare Part 5: Why You Should Accredit Your MIH-CP Program

Accreditation is a review process an organization participates in to demonstrate the ability to meet predetermined criteria and standards of accreditation established by a professional accrediting agency. Achieving accreditation signifies the organization is credible, reputable and dedicated to ongoing and continuous compliance with the highest standard of quality.

Merriam-Webster defines accreditation as “the granting of power to perform various acts or duties.” When you hear the term “accreditation,” you envision things like expertise, professionalism, high standards and quality. Anyone who has gone through an accreditation process would agree those images are certainly accurate, because the process for accreditation requires demonstration that your performance is not only consistent with industry best practices, but that you can prove you are meeting high quality standards. Accreditation insignias are shown with pride on letterhead, websites, banners and vehicles.

Why Accreditation?

Accreditation is regarded as one of the key benchmarks for measuring the quality of an organization. Preparing for accreditation provides an organization with the opportunity to identify its strengths and opportunities for improvement. This process provides information for management to make decisions regarding operations in order to improve the effectiveness and efficiency of business performance.

There are many accreditation agencies that the emergency services community may be familiar with:

• The Commission on Fire Accreditation International (CFAI) provides accreditation programs for fire departments;
• The Commission on Accreditation for Law Enforcement Agencies, Inc. (CALEA) is one of the accreditation agencies for law enforcement agencies;
• The International Academies of Emergency Dispatch (IAED) has accreditation programs for emergency communications centers;
• The Commission on Accreditation of Ambulance Services (CAAS) provides accreditation for ambulance services.

As EMS-based mobile integrated healthcare and community paramedic (MIH-CP) programs continue to mature, a logical next step in the evolution is program accreditation. Further, the Centers for Medicare and Medicaid Services (CMS) often requires certain organizations, programs and/or services to become accredited by an approved accreditor before they are able to participate with Medicare. Accreditation is also a key milestone in elevating an organization's perception with key partner organizations. The conversation with a hospital, health plan, case management or home health CEO becomes much different when they recognize that your agency is accredited, often by the same body that accredits them.

Selecting the Right Accrediting Agency

While the agencies identified above have excellent programs for fire, police, ambulance and emergency communication services, MIH-CP programs don’t really fit the traditional accreditation models of these agencies.

This year, MedStar Mobile Healthcare in Fort Worth decided to apply to the National Committee for Quality Assurance (NCQA) for accreditation for its MIH-CP programs. MedStar selected NCQA because it is widely recognized as continually building consensus around important healthcare quality issues by working with large employers, policy-makers, doctors, patients and health plans to decide what’s important, how to measure it and how to promote improvement.

NCQA’s programs and services reflect a straightforward formula for improvement: measure, analyze, improve, repeat. NCQA makes this process possible in healthcare by developing quality standards and performance measures for a broad range of healthcare entities. These measures and standards are the tools organizations and individuals can use to identify opportunities for improvement. The annual reporting of performance against such measures has become a focal point for the media, consumers and health plans, all of which use these results to set their improvement agendas for the following year.

NCQA’s disease management (DM) evaluation programs include accreditation for organizations that offer comprehensive DM programs with services to patients, practitioners or both, and certification for organizations that provide specific DM functions. The program standards are built on NCQA’s years of experience, detailed market research and input from healthcare industry experts and other stakeholders. NCQA uses performance measures to assess the impact of programs on care for people with chronic conditions such as asthma, diabetes, chronic obstructive pulmonary disease (COPD), heart failure and ischemic vascular disease.

The Accreditation Process

Since MIH-CP in EMS is still in the incubation phase, MedStar began the road to accreditation by meeting with leadership at NCQA at our offices in Washington, DC, in April 2014. MedStar explained the transformation of EMS to MIH services and provided specific program summaries and outcome data for the various programs it conducts in its community. It became quickly apparent to us that this was, for the most part, an entirely new means of service delivery. While aspects of the MIH-CP program conceptually fit existing accreditation requirements, other features may require unique standards for accreditation.

After the initial discussions, MedStar was encouraged to go through the NCQA Disease Management (DM) accreditation process to see if the DM standards were the closest fit for the processes they were using to improve patient outcomes and reduce costs. Tim Penic, one of MedStar’s seasoned MIH-CP practitioners, was selected as the project lead for the accreditation process. Tim led a team that put together documentation, process maps, outcome measures, surveys and answers to specific questions to demonstrate compliance with NCQA’s DM standards.

All organizations applying for NCQA DM accreditation or certification use an online survey tool. The tool guides the organization through documenting performance against the standards and enables electronic submission of information, streamlining the accreditation or certification process. It contains fields for entering data and calculating results. The organization can use the tool to perform a readiness evaluation before the NCQA survey and determine the information it needs to demonstrate how it meets NCQA standards.

Off-Site Survey

Most of the survey process and NCQA’s documentation review occurs during the off-site survey. The survey begins once NCQA formally receives the completed survey tool and supporting documentation. NCQA surveyors access and review the survey tool and supporting documentation to evaluate the organization’s responses and recommend a score for each applicable element and standard. All elements for which surveyors can clearly recommend a score are completed before the on-site survey.

On-Site Survey

During the on-site survey, NCQA surveyors review standards and elements that require access to confidential records, such as patient records, credentialing files and meeting minutes.

NCQA conducts the on-site file review in the presence of the organization’s staff. NCQA may need to review additional information necessary to complete the survey. The onsite survey might include interviews with key staff members or system queries (as applicable), and concludes with a conference to summarize preliminary findings.

The survey team collects and documents its findings and submits them to the Review Oversight Committee, which makes final scoring decisions. The survey team does not make a final determination of the organization’s score on any elements or draw conclusions regarding its accreditation or certification status during the on-site survey.

Reaccreditation

The length of time for which accreditation or certification is effective depends on the organization’s status and under which program they are being accredited. Every two or three years, the organization undergoes a full survey to renew its accreditation or certification status. When the organization receives its results from a survey, NCQA assigns a date for the next required survey.

Accreditation Program Enhancements

As mentioned in the outset of this article, MIH-CP is still in the early development phase and is significantly different than any other service delivery model. It is likely that as MedStar goes through the process, we may identify several opportunities to modify and enhance our current accreditation products or even develop an accreditation model that is specific for EMS-based MIH-CP programs. These are very exciting times for the healthcare system, patients, EMS agencies and NCQA. We are happy to be part of the development of these programs and look forward to working with the EMS community to enhance your service delivery models and prove the value of the services you provide.

What Accreditation Shows

NCQA-accredited DM organizations show that they:

• Provide comprehensive programs delivering evidence-based care
• Make efficient use of resources
• Have high levels of customer satisfaction
• Deliver improved health outcomes.

NCQA-certified DM organizations demonstrate that they:

• Provide evidence-based content and systems to support comprehensive DM programs
• Drive quality care and services by addressing patient safety and delivering improved services.

NCQA Disease Management Standards

NCQA’s DM standards are organized into seven categories:

1. Evidence-Based Programs

Organizations should use the best clinical evidence to develop program content. Program principles include:

• Using evidence-based guidelines or standards of care in developing program content for patients and practitioners
• Ensuring that all content is consistent with adopted guidelines
• Ensuring appropriate practitioner oversight of programs.

2. Patient Services

Organizations should work with patients to encourage self-management behavior that enables good outcomes. Patient service principles include:

• Using available clinical data from the client organization or from eligible participants to identify potential participants and stratify them for assignment to different levels of service intensity
• Integrating relevant patient data to produce actionable patient-level information
• Enlisting and measuring active participation of eligible patients
• Supporting patient self-management with consumer-tested information, coaching, reminders and referrals
• Stating a commitment to patient rights, including the right to opt out of the program, and expectations of patient responsibilities
• Encouraging patient and practitioner communication.

3. Practitioner Services

Organizations should support the practitioner’s care plans by providing actionable and timely information on their patients’ conditions. Practitioner services principles include:

• Supporting practitioner decisions with evidence-based recommendations on care of chronic conditions
• Providing practitioners with feedback on care opportunities that must be addressed
• Stating a commitment to practitioner rights and encouraging practitioners to work with the program to coordinate patient care.

4. Care Coordination

Organizations should make care plan information accessible to patients and practitioners. Care coordination principles include:

• Giving patients information about their progress toward treatment goals
• Giving practitioners information about the condition and progress of their patients
• Coordinating referrals and providing relevant information to case management programs and other health resources

5. Measurement and Quality Improvement

Organizations should measure patient and practitioner data to assess their experience and act to improve quality where necessary. Standards are designed to impose principles of good measurement that include:

• Measuring quality across the organization and for each condition managed
• Ensuring that all eligible participants are included in the measured population
• Using evaluative patient and practitioner data to assess experience with the DM program for quality improvement
• Measuring cost or efficiency across each program
• Analyzing performance data, taking action for quality improvement and demonstrating improvement in performance.

6. Program Operations

Organizations should support and maintain their DM programs by:

• Ensuring convenient access to the organization for patients and practitioners
• Considering patients with special needs
• Employing qualified personnel and giving them the necessary training
• Disclosing marketing activities
• Responding appropriately to patient and practitioner complaints
• Using available information to address patient safety issues
• Protecting the privacy of patient information.

7. Performance Measurement
Organizations should regularly assess their performance.

Patricia Barrett joined NCQA in 2008 and currently serves as its vice president for product design and support. In this role, she is responsible for exploring new product concepts and evolving existing products to meet the needs of a changing healthcare environment. She also ensures proper development, communication and interpretation of NCQA accreditation, certification and recognition standards, as well as Healthcare Effectiveness Data and Information Set (HEDIS) and other performance measures. Barrett attended the University of Michigan receiving her bachelor’s degree in sociology and a master’s degree in Health Services Administration from the School of Public Health.

The National Committee for Quality Assurance is a private 501(c)(3) not-for-profit organization dedicated to improving healthcare quality. Since its founding in 1990, NCQA has been a central figure in driving improvement throughout the healthcare system, helping to elevate the issue of healthcare quality to the top of the national agenda.