Communitas Achieves 3-Year NCQA Accreditation for Case Management and Utilization Management Programs
Communitas is redefining health care clinical management by prioritizing health outcomes through comprehensive member engagement.
IRVING, Tx. – January 2024 – Communitas, Inc., an industry leader in health care management, announces achieving a three-year National Committee for Quality Assurance (NCQA) Accreditation for its case management (CM) and utilization management (UM) programs, effective January 2024. Communitas is an affiliate of WebTPA Employer Services LLC, a GuideWell company.
NCQA is a non-profit organization that is the gold standard in the health care industry, focused on improving health care quality and recognizes companies that lead the market in administrating evidence-based standards and procedures.
3-Year Case Management Accreditation
The Case Management Accreditation rigorously assesses organizational efficiency, cost-effectiveness, and patient-centered care delivery.
“Case Management Accreditation moves us closer to measuring quality across population health management initiatives,” said Margaret E. O’Kane, president, NCQA. “Not only does it add value to existing quality improvement efforts; but it also demonstrates an organization’s commitment to the highest degree of improving the quality of their patients’ care.”
With this accreditation, Communitas advances its commitment to meaningful population health management. It leverages a robust clinical platform with advanced analytics and risk stratification programs to proactively connect with members, helping them get the right care at the right time from the right provider which leads to better health outcomes.
3-Year Utilization Management Accreditation
NCQA’s Utilization Management Accreditation evaluates how well health professionals in an organization make fair and timely utilization management decisions by using objective, evidence-based clinical criteria in accordance with state requirements.
“Achieving NCQA Utilization Management/Credentialing Accreditation demonstrates that Communitas has the systems, process and personnel in place to conduct utilization management in accordance with the strictest quality standards,” said O’Kane.
In tandem with this accreditation, Communitas upholds the highest of care standards through a distinguished panel of medical staff. This clinical team, comprised of medical directors and 13 other physicians representing diverse specialties, intervenes to better understand patients’ care plans to help ensure they receive the safest, most cost effective care available.
“In a health care landscape often marked by complexity, NCQA provides standards of quality and excellence in health care,” said Brandon Maenius, senior vice president of Communitas. “For Communitas, it underscores our mission of Bringing Clarity to Chaos by guiding us in our relentless pursuit of delivering superior, compassionate care for the members and health plans we serve.”
Communitas specializes in Utilization Management, Case Management, and Member Advocacy and Navigation, delivering a cohesive and highly personalized member experience that prioritizes health outcomes while reducing the cost of care. Headquartered in Irving, TX, Communitas serves over 193,000 members across the nation. Founded in 2010, they are an affiliate of WebTPA Employer Services, a GuideWell company, and share their mission to help people and communities achieve better health.
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.