BREA, Calif.--(BUSINESS WIRE)--NCH Management Systems, Inc., D/B/A New Century Health (NCH), a national leader in specialty care management, today announced it has been accredited in Utilization Management by the National Committee for Quality Assurance (NCQA). Utilization management (UM) encompasses the evaluation of the medical necessity, appropriateness and efficiency of the use of health care services, procedures and facilities under the provisions of an applicable health benefits plan.
Focusing on oncology and cardiology, NCH helps payers and providers improve patient outcomes and contain costs through high-value clinical pathways, alternative payment models and utilization management programs.
“NCQA accreditation confirms that we are aligned with the highest expectations for utilization management,” said NCH President Scott Pritchard. “We are proud to demonstrate this key aspect of our value to our health plan partners. This achievement validates our commitment to ensure patients receive high-quality, clinically appropriate therapies that are also cost-effective.”
New Century Health has been URAC-accredited in Health Utilization Management since 2011. NCH decided to pursue prestigious NCQA accreditation in 2019 to align with existing and prospective payers’ expectations for accreditation, quality assurance programs and delegation oversight.
NCQA Utilization Management Accreditation focuses on consumer protection and improvement in service to customers. Standards recognize that organizations that apply for accreditation have open access networks and can improve service quality and utilize customized structures to meet purchaser needs.
“Achieving NCQA Utilization Management Accreditation demonstrates that New Century Health has the systems, process and personnel in place to conduct utilization management in accordance with the strictest quality standards,” said Margaret E. O’Kane, NCQA president.
NCQA has reviewed and accredited NCH’s Utilization Management functions only. For complete details on the scope of this review, visit www.ncqa.org.
In addition, NCH has also received HITRUST CSF® Certification for its CarePro and GHIS SaaS applications. The HITRUST CSF framework is a rigorous process that provides organizations with a comprehensive, flexible, and efficient approach to regulatory compliance and risk management. It was developed to address the multitude of security, privacy and regulatory challenges facing organizations, including Health Information Portability and Accountability Act (HIPAA) regulations. By including federal and state regulations, standards and frameworks, and incorporating a risk-based approach, the HITRUST CSF helps organizations address these challenges through a comprehensive and flexible framework of prescriptive and scalable security and privacy controls. NCH received initial HITRUST certification in 2017. Recertification demonstrates NCH’s commitment to uphold the highest data security standards and privacy protection in maintaining electronic protected health information for the hundreds of thousands of patients in its system.
About New Century Health
New Century Health is the nation's leading specialty care management company, with special focus on cancer and cardiology patients. New Century Health partners with specialty providers and health plans to provide them with clinical decision and population health management tools to ensure that cancer and cardiology patients receive the highest quality, most affordable care. New Century Health has been URAC-accredited in Health Utilization Management since 2011 and received NCQA accreditation in Utilization Management in June 2020. New Century Health is a wholly owned subsidiary of Evolent Health. To learn more about New Century Health, please visit newcenturyhealth.com.
NCQA is a private, nonprofit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care. NCQA’s website (ncqa.org) contains information to help consumers, employers and others make more informed health care choices. NCQA can be found online at ncqa.org, on Twitter @ncqa, on Facebook at facebook.com/NCQA.org/ and on LinkedIn at linkedin.com/company/ncqa.
Since it was founded in 2007, HITRUST has championed programs that safeguard sensitive information and manage information risk for organizations across all industries and throughout the third-party supply chain. In collaboration with privacy, information security and risk management leaders from the public and private sectors, HITRUST develops, maintains, and provides broad access to its widely adopted common risk and compliance management frameworks as well as related assessment and assurance methodologies. For more information, visit www.hitrustalliance.net.