Are you trying to understand the new standards for NCQA’s Health Plan Accreditation (HPA)? Health plans have already been meeting some of the requirements of the new Population Health Management category. Others are new standards. So why the change?
The National Committee for Quality Assurance (NCQA) updated their accreditation standards for health plans to reflect a focus on whole-person, integrated care. The new PHM category requires quality data, thoughtful analysis, and strategic interventions through a coordinated delivery system.
PHM 1: PHM Strategy (NEW): Comprehensive population health strategy with defined goals aimed at helping members get healthy, stay healthy, and manage existing chronic disease(s).
PHM 2: Population Identification (NEW): Data integration and analysis to connect members with programs or services that provide appropriate intervention.
PHM 3: Delivery System Supports (NEW): Coordination with providers or practitioners to provide value-based care that meets population health management goals.
PHM 4: Wellness and Prevention (formerly part of Member Connections): Risk identification and educational intervention through evidence-based tools.
PHM 5: Complex Case Management (formerly part of Quality Management and Improvement): Coordinating access to resources that ensure complex, highest-risk members receive care.
PHM 6: Population Health Management Impact (NEW): Analysis to determine the effectiveness of population health management efforts and any future actions.
In explaining the reason for the update to the standards, NCQA’s Vice President for Product Design and Support Patricia M. Barrett said, “The future is integration: integration across providers and practices, integration between health plans and the delivery system, integration of strategies to support patients. These standards take the first step toward that integration, encouraging and rewarding health plans for aligning with the delivery system in pursuit of better population health outcomes.”
Seeking NCQA Health Plan Accreditation?
The WellSuite® Health Risk Assessments and Self-Management Tools (Health Shelf®) will make NCQA accreditation a little easier for you. Here’s how:
- WellSuite® IV Health Risk Assessment – PHM 4, Elements A through G (formerly MEM 1)
- Health Shelf® – PHM 4, Elements F through K (formerly MEM 2)
Nearly 40 years ago, Wellsource, Inc. combined lifestyle management principles with technology. Our products deliver actionable data that informs decisions and leads to improved outcomes. We received NCQA certification in 2008 – making us one of the first organizations to be certified for health information products. And we've been continuously certified ever since.
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