New NCQA Population Health Management Standards

The recently announced National Committee for Quality Assurance (NCQA) 2018 Health Plan Accreditation (HPA) standards and guidelines include a new category: Population Health Management (PHM). PHM combines existing standards, such as wellness and complex case management, with data analytics for identifying population needs, targeting resources to the right individuals, and evaluating the impact of their strategy. These changes allowed removal of a number of outdated standards, such as disease management and practice guidelines, resulting in a net reduction of seven elements.

The PHM category includes six standards:

  • 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: Population Health Management Impact

Standards for health appraisals and self-management tools have moved from the Member Connection (MEM) standards to PHM 4, Elements A-K.  PDHI maintains Wellness and Health Promotion (WHP) certification for ConXus Profile (health risk assessment) and ConXus Steps (self-management tools). Health plans using these ConXus modules receive automatic credit when undergoing NCQA Health Plan Accreditation for the following standards:

  • 2017 MEM 1: Health Appraisals and MEM 2: Self-Management Tools
  • 2018 PHM 4: Wellness and Prevention, Elements A-K

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