NCQA New Products, Developments in Population Health Management

October 9, 2018

Natalie Mueller, MPH, of NCQA, recently explained NCQA’s shift towards population health management and discussed two new products, during a session at HQC 2018.

Ms Mueller began the session by defining population health management. She said that it is comprised of data integration, stratification, measurement, care delivery system, health plans and payers, community, and population identification. According to Ms Mueller, there is a multi-step journey to achieve population health, including the triple aim—which combines population health, per capita costs, and experience of care—Affordable Care Act and Medicare and CHIP Reauthorization Act, PHM Category in Health Plan Accreditation, and finally new products.

The NCQA population health management (PHM) Health Plan Accreditation category consists of:

  • PHM 1: PHM Strategy
  • PHM 2: Population Identification
  • PHM 3: Delivery System Supports
  • PHM 4: Wellness and Prevention
  • PHM 5: Complex Case Management
  • PHM 6: PHM Impact
  • PHM 7: Delegation of PHM

The new two products from NCQA are Accreditation Prevalidation, which is intended for health IT vendors performing discrete PHM functions, and Population Health Program Accreditation, which is intended for organizations managing specific populations and provider organizations.

Accreditation Prevalidation

According to Ms Mueller, this product will review a vendors solutions against HPA standards that demonstrate the capability in meeting standards. This product performs a virtual review, and no system will be needed. Additionally, it provides burden relief and automatic credit for health plans.

The applicable elements for PHM Prevalidation for Health IT Vendors, includes:

  • PHM 2A: Data Integration
  • PHM 2B: Population Assessment
  • PHM 2D: Segmentation
  • PHM 5B: Case Management Systems

This tool meets factor and element requirements, but according to Ms Mueller, it does not perform the function directly and offers the tool or ability to produce required reports. Additionally, the tool demonstrates competency for the entire function outlined in the element or factor. Further, the health plan receives a score of “met” for an eligible requirement.

Population Health Program Accreditation

Ms Mueller explained that this new product provides chronic-condition or population focused programs, follows the PHM model, and provide burden relief and automatic credit for health plans.

The accreditation standers under this program include:

  • PHP 1: Program Description
    • Element A: Program Description
    • Element B: Systematic Review of Evidence
    • Element C: Program Content Consistent with Evidence
    • Element D: Program Information
  • PHP 2: Data Integrations
    • Element A: Data Integration
  • PHP 3: Population Assessment
    • Element A: Population Assessment
    • Element B: Activities and Resources
  • PHP 4: Population Segmentation
    • Element A: Segmentation
  • PHP 5: Targeted Interventions
    • Element A: Providing Individual Interventions (file review)
  • PHP 6: Practitioner Support
    • Element A: Communicating with Practitioners
  • PHP 7: Measurement and Quality Improvement
    • Element A: Measuring Clinical Quality
    • Element B: Analyzing Experience Data
    • Element C: Analyzing Patient-Reported Outcomes
    • Element D: Comprehensive Analysis
    • Element E: Improvement and Action
    • Element F: Participation Rates
    • Element G: Transparency in Reporting Outcomes
  • PHP 8: Individuals’ Rights and Responsibilities
    • Element A: Individuals’ Rights and Responsibilities
    • Element B: Individuals’ Experience
    • Element C: Handling Individuals’ Complaints
    • Element D: Resolving Complaints

Ms Mueller noted, “An organization that uses an NCQA-Accredited PHP organization is eligible to receive delegation oversight relief in PHM 7: Delegation Oversight, as stated in PHM 7, Elements B-D.”

Both new products are expected to launch on December 3, 2018.

Julie Gould