The Population Health Program Accreditation (PHP Accreditation) Webinar

Wednesday, January 16, 2019 | Webinar 2:00pm – 3:30pm ET

Information presented in this NCQA Education program is verified for accuracy before its presentation. In the event of any real or perceived conflict with an NCQA publication, the publication and/or any in-force published correction, clarification or policy change, including a Frequently Asked Question (FAQ) or Policy Update document posted on the NCQA Website, takes precedence.

© (2019) by the National Committee for Quality Assurance 1100 13th Street, NW, Third Floor, Washington, DC 20005 202/955-3500 202/955-3599 (fax) www.ncqa.org All rights reserved. Printed in the USA.

No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission.

NCQA Contact Information Customer Support 888-275-7585

• General Information • Educational Seminar Registration • Publications Center

NCQA Website www.ncqa.org

Policy Clarification Support

https://my.ncqa.org/

PCMH CEC http://www.ncqa.org/cec

Table of Contents Section 1 Webinar Information Section 2 Slide Presentation

Webinar Information

The Population Health Program Accreditation (PHP Accreditation) Webinar

This 90-minute program is designed for the new and seasoned participant preparing for NCQA’s Population Health Program Accreditation. It provides an overview of the Population Health products and the NCQA Accreditation process. Additionally, the PHP Accreditation requirements will be reviewed, focusing on preparing for a survey and eligibility requirements. This educational webinar series will include a live question and answer session following the presentation.

Agenda Welcome Natasha Reid, MA, PAHM, Program Manager, Education

Presenter Natalie Mueller, MPH, Manager, Product Development

Open Discussion/Question and Answer Session

Closing Remarks

Objectives

• Explain NCQA’s definition of population health management. • Describe the PHP Accreditation requirements. • Discuss the eligibility requirements needed to apply for PHP Accreditation. • List the benefits of Populations Health Program Accreditation. • Learn how to apply for Population Health Program Accreditation.

Continuing Education This live webinar provides maintenance of certification credit of 2 points under ‘other continuing education’ for PCMH CCEs. This is a non CME/CNE/CPE/APA/ASWB/AAPA activity. * Please note – You must attend the entire program to be eligible for total number of contact hours.

Disclosure of Relevant Financial Relationships with Commercial Companies/Organizations

The Population Health Program Accreditation

(PHP Accreditation) Webinar January 16, 2019

The National Committee for Quality Assurance (NCQA) endorses the Standards of the Accreditation Council for Continuing Medical Education which specify that sponsors of continuing medical education activities and presenters at and planners for these activities disclose any relevant financial relationships either party might have with commercial companies whose products or services are discussed in educational presentations. For sponsors, relevant financial relationships include large research grants, institutional agreements for joint initiatives, substantial gifts, or other relationships that benefit the institution. For presenters or planning committee members, relevant financial relationships include the receipt of research grants from a commercial company, consultancies, honoraria, travel, or other benefits, or having a self-managed equity interest in a company; or having an immediate family member or partner with such a relationship. Disclosure of a relationship is not intended to suggest or condone bias in any presentation, but is made to provide participants with information that might be of potential importance to their evaluation of a presentation. Relevant financial relationships exist with the following companies/organizations:

Faculty: Natalie Mueller: None Additional Planning Committee: Tina King: None Natasha Reid: None This program was developed by NCQA staff. This program received no commercial support.

Faculty

Natalie Mueller, MPH Manager, Product Development NCQA Washington, DC

Faculty Biographies

Natalie Mueller, MPH

Natalie is a Manager in Product Development and has been with NCQA since 2015. In this role, she updates existing accreditation products and creates new accreditation and certification products to meet market and customer needs. She currently leads the Population Health Management project, transforming NCQA’s flagship product, Health Plan Accreditation, from single-condition management towards a population health-based approach that focuses on whole-person care.

This work will go beyond Health Plan Accreditation as other accreditation and certification products are adapted for the new approach. She attended Penn State University where she received her Bachelor of Science in Nutritional Science and the University of Pittsburgh for her Master in Public Health.

Slide Presentation

1/14/2019

1

Introduction to Population Health Program Accreditation

Natalie Mueller, MPH

Product Development ManagerAll materials © 2019 National Committee for Quality Assurance

New Product:

Population Health

Program Accreditation

Population Health

Management (PHM)

Category in Health

Plan Accreditation

(HPA)

The Triple Aim: population

health, per capita costs,

experience of care

Journey to Population Health Management

Affordable Care Act and

Medicare and CHIP

Reauthorization Act

2

1

2

1/14/2019

2

What is population health management?

A model of care that strives to address patients’ health needs at all points along

the continuum of care, including the community setting, by increasing patient

participation and engagement and targeting interventions.3

Population Health Program Accreditation

4

• Accrediting chronic-condition or

population focused programs (similar

to Disease Management Accreditation)

• Follows PHM model

• Population health programs may

contribute to a health plan’s overall

PHM strategy

3

4

1/14/2019

3

Population Health Management (PHM) in HPA vs. Population Health Program (PHP) Accreditation

5

PHM category in HPA

PHM describes a model of care across all levels of risk

A category of standards in HPA product, requiring that health plans have a strategy to manage 100% of their members across the entire continuum of care

PHP Accreditation

A standalone accreditation

For programs that may focus on a specific population or chronic condition; not necessarily all levels of risk

May be a piece of a health plan’s overall comprehensive PHM strategy

Will NCQA’s Wellness and Health Promotion (WHP) and Case Management (CM) Accreditations/Certifications

be rolled into PHP Accreditation?

6

➢ Not at this time! Currently there are no plans to

include WHP or CM standards in PHP Accreditation.

5

6

1/14/2019

4

PHP AccreditationGeneral Questions

8

Important dates for PHP Accreditation

December 3, 2018

- Release Date

January 1, 2019

- Effective date for standards

July 1, 2019

- Surveys begin

7

8

1/14/2019

5

What is the cost for PHP Accreditation?

Application Fee: $5,000

+ Base Fee

+ Per Individual Fee

+ Per Program Fee (First 1-5 programs, no additional fee)

9

Full Survey

Base Fee $25,000

Per Individual Fee $0.15

Per Program Fee* $2,000

10

Eligibility: What types of organizations may qualify for NCQA’s PHP Accreditation?

Population

Health

Management

Organizations

Provider

Organizations

Disease

Management

Organizations

Health Plans Case

Management

Organizations

Many different types of organizations have programs that focus on managing specific risk factors to targeted populations or specific conditions…

9

10

1/14/2019

6

11

What are the scoring thresholds?

= 85-100%

= 70-84.99%

Did you know? There are 2 must-pass elements,

scoring less than 50% on the must-

pass elements results in denied

status.

Automatic Credit for Health Plan Accreditation (HPA)

If a Health Plan meets other automatic credit rules, PHP

Accreditation may qualify as automatic credit for up to 2.15

points in HPA’s PHM category of standards (26% of the

category’s total points):

❖PHM 1, Element B: Informing Members

❖PHM 2, Element A: Data Integration

❖PHM 2, Element B: Population Assessment

❖PHM 2, Element C: Activities and Resources

❖PHM 2, Element D: Segmentation

❖PHM 3, Element A: Practitioner or Provider Support (factor

6)

12

11

12

1/14/2019

7

PHP Accreditation Requirements

PHP Accreditation Standards

PHP 3: Population Assessment

14

PHP 2: Data Integration

PHP 4: Population Segmentation

PHP 5: Targeted Interventions

PHP 1: Program Description

PHP 6: Practitioner Support

PHP 7: Measurement and Quality Improvement

PHP 8: Individual Rights and Responsibilities

13

14

1/14/2019

8

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

15

The organization uses up-to-date evidence-based information to develop the program,

and regularly updates the program with relevant findings and information.

16

The organization’s program description includes:

1. Evidence used to develop the program.

2. Criteria for identifying individuals who are

eligible for the program.

3. Services offered to individuals.

4. Defined program goals.

PHP 1A: Program Description

15

16

1/14/2019

9

17

Every two years, the organization performs a

systematic review of:

1. Evidence used to develop the program.

2. New evidence (including clinical or technical

literature or government research sources) by

at least two appropriate practitioners.

PHP 1B: Systematic Review of Evidence

18

For its programs, the organization:

1. Reviewed program content against evidence used to

develop the program.

2. Assessed whether program materials are consistent

with current evidence, and if they are not, that it took

action to make them consistent.

3. Assessed whether staff training materials are

consistent with current evidence, and if they are not,

that it took action to make them consistent.

4. Reviewed program content for cultural and linguistic

appropriateness.

PHP 1C: Program Content Consistent with Evidence

17

18

1/14/2019

10

19

The organization provides eligible individuals with written

information about:

1. How to use the organization’s services.

2. How individuals become eligible to participate.

3. Hours of operation and contact information, including

telephone number, website and email addresses, if

applicable.

4. How to communicate a complaint or provide feedback.

5. Whom to contact in an urgent situation.

6. How to opt in or opt out of the program.

PHP 1D: Program Information

PHP 2: Data Integration

Element A: Data Integration

20

The organization systematically collects and integrates relevant data to product

actionable information.

19

20

1/14/2019

11

21

The organization integrates the following data to use for

population health functions:

1. Medical and behavioral claims or encounter data.

2. Eligible individual list from client organizations.

3. Pharmacy data.

4. Laboratory results.

5. Health appraisal results.

6. Data collected through the utilization management,

case management or care management process.

7. Data from health management, wellness or health

coaching programs.

8. Electronic health records.

9. Information collected from individuals, practitioners

and client organizations.

10. Advanced data sources.

PHP 2A: Data Integration

PHP 3: Population Assessment

Element A: Population

Assessment

Element B: Activities and

Resources

22

To facilitate interventions, the organization uses appropriate data to assess its

population.

21

22

1/14/2019

12

23

The organization annually:

1. Assesses the characteristics and needs of the

population, including social determinants of health*.

2. Identifies and assesses the needs of relevant

subpopulations*.

3. Assesses the needs of children and adolescents.

4. Assesses the needs of individuals with disabilities.

5. Assesses the needs of individuals with serious and

persistent mental illness (SPMI).

PHP 3A: Population Assessment

24

The organization annually uses the population

assessment to:

1. Review and update its activities to address

individuals’ needs.

2. Review and update its resources to address

individuals’ needs.

3. Integrate community resources into program

offerings to address individuals’ needs.

PHP 3B: Activities and Resources

23

24

1/14/2019

13

PHP 4: Population Segmentation

Element A: Segmentation

25

The organization uses appropriate data or information to segment or stratify

individuals into actionable categories for intervention.

26

At least annually, the organization segments or

stratifies its entire population into subsets for

targeted intervention.

PHP 4A: Segmentation

25

26

1/14/2019

14

PHP 5: Targeted Interventions

Element A: Providing

Individual Interventions (file review)

27

The organization provides appropriate targeted interventions to individuals.

28

The organization demonstrates that interventions:

1. Are delivered to individuals based on the intervention

plan.

2. Include person-centered goals.

PHP 5A: Targeted Interventions

For internal NCQA use ONLY

27

28

1/14/2019

15

PHP 6: Practitioner Support

Element A:

Communicating with

Practitioners

29

The organization informs practitioners of care opportunities that require their attention.

30

The organization:

1. Informs the practitioner on record about care

opportunities that need to be addressed in a

timely manner.

2. Collaborates with the practitioner by soliciting

input or advice, when necessary.

PHP 6A: Communicating with Practitioners

29

30

1/14/2019

16

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 31

The organization measures, analyzes, and works to improve experience, program

effectiveness and participation.

32

Using at least two measures, the organization annually

evaluates the effectiveness of its program(s). For each

measure, the organization:

1. Identifies a relevant process or outcome.

2. Uses a valid method that provide quantitative results.

3. Sets a performance goal.

4. Clearly identifies measure specifications.

5. The measure is population based.

PHP 7A: Measuring Clinical Quality

31

32

1/14/2019

17

33

At least annually, the organization evaluates

individuals’ experience by analyzing feedback on:

1. The overall program.

2. The program staff.

3. Usefulness of the information disseminated.

4. Ability of individuals to adhere to recommendations.

5. Whether the program helped individuals achieve

health goals.

6. Complaints from individuals.

PHP 7B: Analyzing Experience Data

34

PHP 7C: Analyzing Patient-Reported Outcomes

At least annually, the organization evaluates patient-

reported outcomes by analyzing:

1. A measure of patient-reported health outcomes.

2. A second measure of patient-reported health

outcomes.

33

34

1/14/2019

18

35

At least annually, the organization conducts an analysis

of the impact of the program that includes the following:

1. Quantitative results measured in Elements A–C.

2. Comparison of results with a benchmark or goal.

3. Interpretation of results.

PHP 7D: Comprehensive Analysis

36

The organization uses results from the analysis to

annually:

1. Identify opportunities for improvement.

2. Act on one opportunity for improvement.

PHP 7E: Improvement and Action

35

36

1/14/2019

19

37

At least annually, the organization measures

participation rates.

PHP 7F: Participation Rates

38

The organization is transparent about the methods it

uses to calculate the impact of its measures.

PHP 7G: Transparency in Reporting Outcomes

37

38

1/14/2019

20

PHP 8: Individuals’ Rights and Responsibilities

Element A: Individuals’ Rights

Information

Element B: Individuals’

Expectations

Element C: Handling Individuals’

Complaints

Element D: Resolving

Complaints

39

Individuals understand what they are entitled to and what is expected of

them while enrolled in the program.

40

The organization distributes written information to individuals that addresses their right to:

1. Have information about the organization (including programs and services provided on

behalf of the client organization), its staff and its staff’s qualifications and any contractual

relationships.

2. Decline participation in or disenroll from programs and services offered by the

organization.

3. Know which staff are responsible for managing their services and from whom to request

a change.

4. Be supported by the organization to make health care decisions interactively with their

practitioners.

5. Be informed of all treatment options included or mentioned in clinical guidelines, even if a

treatment is not covered, and to discuss options with treating practitioners.

6. Have personal identifiable data and medical information kept confidential; know what

entities have access to their information; know procedures used by the organization to

ensure security, privacy and confidentiality.

7. Be treated courteously and respectfully by the organization’s staff.

8. Communicate complaints to the organization and receive instructions on how to use the

complaint process, including the organization’s standards of timeliness for responding to

and resolving issues of quality and complaints.

9. Receive understandable information.

PHP 8A: Individuals’ Rights and Responsibilities

39

40

1/14/2019

21

41

The organization has a policy for distributing individuals’

expectations information and distributes written

information to individuals that addresses the expectation

that they will:

1. Participate in the program offered by the

organization.

2. Provide the organization with information necessary

to carry out its services.

3. Notify the organization and the treating practitioner if

an individual disenrolls from the program.

PHP 8B: Individuals’ Expectations

42

The organization has policies and procedures for registering

and responding to verbal and written complaints. Policies and

procedures include:

1. Documentation of the substance of complaints and

actions taken.

2. Investigation of the substance of complaints, including any

aspect of clinical care involved.

3. A process for triaging complaints that are not about the

organization, its staff or the services that it provides to

appropriate parties and to the client, if applicable.

4. Notification and update individuals on the progress of the

investigation.

5. Notification to individuals of the disposition of complaints.

6. Standards for timeliness, including standards for clinically

urgent situations.

PHP 8C: Handling of Individuals’ Complaints

For internal NCQA use ONLY

41

42

1/14/2019

22

43

The organization documents:

1. Resolution of individuals’ complaints.

2. Turnaround times for resolution of individuals’

complaints.

PHP 8D: Resolving Complaints

DM Accreditation and DM Certification Transition

43

44

1/14/2019

23

Next steps for NCQA’s Disease Management Accreditation and Disease Management Certification

45

Applications for DM Accreditation and

Certification Accepted until

November 2019

Surveys must be scheduled prior to

July 2020

46

Disease Management

Population Health

Program

For current DM Accredited Organizations, NCQA offers multiple

pathways to transition to PHP Accreditation:

1. Undergo full PHP Accreditation survey and maintain both

accreditations

2. Extend DM Accreditation status until PHP Accreditation survey is

completed, avoiding a lapse in accreditation status

3. Undergo the “DM Transition to PHP” survey

• PHP status expires at the same time as DM

• Maintain both Accreditation statuses

45

46

1/14/2019

24

Conclusion

48

To apply to Population Health Program Accreditation: my.ncqa.org

Accreditation at the organization level

Closely related to the HPA’s PHM category of standards

Some standards reviewed by program level; others for the organization as a whole

One file review element, conducted on-site

Offers automatic credit for the PHM standards for HP, MBHO, ACO, CM

47

48

1/14/2019

25

Questions

49