August 3, 2006
DANVILLE, Pa.—Geisinger Health Plan (GHP) is one of five health plans nationally to receive Full Accreditation from the National Committee for Quality Assurance (NCQA)*. GHP received Full Patient and Practitioner Accreditation for eight disease management programs for patients with complex, chronic conditions.
Seven of the programs; asthma care, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), coronary heart disease, diabetes care, hypertension, and osteoporosis, were reaccredited. Chronic kidney disease also received accreditation from NQCA. The three-year accreditations included a review of practitioners' care processes as well as patients' recommended activities.
NCQA is an industry leader in the effort to assess, measure and report on the quality of care provided by managed care organizations. Providing unbiased, accurate information, NCQA assists individuals and employers in making informed choices about their health-care options. The NCQA Disease Management Accreditation and Certification Program, launched in December 2001, helps to standardize quality of care in the industry. Geisinger Health Plan is one of just 35 organizations nationwide to receive accreditation from NCQA*.
GHP underwent a comprehensive review of the full range of disease management functions including: program content; patient service; practitioner service; clinical systems; measurement and quality improvement; and program operation.
“NCQA’s Disease Management accreditation program is thorough and rigorous. It is designed to highlight only those programs that truly improve chronic care,” said NCQA President Margaret E. O’Kane. “Geisinger Health Plan is to be commended for being one of the first organizations in the nation to come forward and be reviewed.”
Evidence-based outcomes show that managing chronic conditions helps to improve the lives of those suffering from chronic illnesses, and health plans are increasingly turning to these programs as part of the solution to its quality and cost challenges. Through the use of case managers, Geisinger Health Plan touches members who are participating in these programs. These health care professionals work with hundreds of GHP members to help members feel better and improve their quality of lifewhile empowering them to take a more active role in their health.
Registered nurses employed by the Health Plan are based in primary care clinics throughout its 40-county service area to work one-on-one with members and provide additional support to physicians. This enables each nurse to focus solely on disease management, spend more time with members, provide the best quality of care, and effectively monitor a patient’s progress.
Disease management programs can also help employers respond to rising health-care costs. The use of disease management can direct members to appropriate health care services, increase productivity by reducing the number of employee sick days, promote employee retention, make employees in the program less likely to move to another employer, and help to create a better work environment for employees.
Geisinger Health Plan has also restructured the health management programs to better serve members’ needs. In addition to providing disease management services, case managers will coordinate care for chronic conditions such as pneumonia or after discharge from a hospital, rehabilitation or nursing facility. The purpose of the contact is to make sure members are taking medications as prescribed, have an appointment for follow-up care, and review other important issues.
“This distinguished accreditation confirms the quality of Geisinger Health Plan’s disease management programs. It reflects our commitment to provide a high level of care and service to obtain the best outcomes for our members,” stated Duane Davis M.D., vice president and chief medical officer of the Health Plan. “Since we have restructured our health management department, we are better able to provide these services to more of our members.”
Begun in 1985, Geisinger Health Plan, a not-for-profit health maintenance organization (HMO), serves the health-care needs of 200,000 members in 40 counties throughout central and northeastern Pennsylvania. In addition to the eight accredited programs, GHP offers a program in tobacco cessation. In 2004, Geisinger Health Plan received an “Excellent” designation from NCQA for its commercial HMO product. Coverage is available for businesses of all sizes, individuals and families, and Medicare beneficiaries. Geisinger Indemnity Insurance Company, an affiliate of Geisinger Health Plan, began offering third-party administration services for self-funded employers in 1996 and has grown to include indemnity insurance and PPO plans.
*as of June 29, 2006
For more information, please contact
Amy Bowen, Public Relations Coordinator (570) 271-8135