Population Health Program Accreditation FAQs

What is Population Health Program Accreditation?

NCQA Population Health Program Accreditation is a comprehensive program dedicated to quality improvement that evaluates the operations of population- or disease-specific population health management programs. NCQA-Accredited organizations demonstrate they have the processes to provide person-centered services to a defined population.

How does Population Health Program Accreditation help my organization?

Use the NCQA Population Health Program Accreditation standards to perform a gap analysis and determine improvement areas. Standards provide a framework for implementing best practices to synchronize care and:

• Increase efficiency and the ability to manage complex individuals better.
  • Systematically collect, integrate and assess data to inform, measure and operate your population health program.
  • Assess your population’s needs; update activities and resources using results.
  • Segment populations for targeted interventions.
  • Provide targeted interventions based on level of need.
  • Provide support to practitioners.
  • Measure individual experience, program effectiveness, cost and participation rates.
• Implement effective, targeted population health programs to meet contracting arrangements.
  • Offer automatic credit to health plans seeking Accreditation for eligible population health management requirements, reducing administrative efforts.

What are the Population Health Program Accreditation requirements?

NCQA Population Health Program Accreditation requirements ensure that organizations align their operations with population health management best practices, improving management of individuals with complex needs and adding efficiency. Requirements cover these key areas:

• Data integration.
• Population assessment.
• Population segmentation.
• Targeted interventions.
• Practitioner support.
• Measurement and quality improvement.

Eligible programs must be person-centered and may:

• Address a single disease or condition (e.g., diabetes, asthma, high-risk pregnancy), or
• Address multiple conditions to manage specific risk factors in a targeted population (e.g., reduction of inpatient admissions for ambulatory-sensitive conditions).

Where can I find the Standards and Guidelines?

Get the Standards & Guidelines document in the NCQA eStore to see all program requirements.

What organizations are eligible for Population Health Program Accreditation?

Population Health Program Accreditation is for organizations that:

• Perform functions covered in the Accreditation program or arrange for functions to be performed, directly or through a service agreement.
• Manage enough members to constitute a valid sample for NCQA evaluation (where standards require patient file review).
• Have population health programs in operation for a minimum of 6 months when the application and contract are submitted.

What is the process for earning Population Health Program Accreditation?

The first step to earning Accreditation is a discussion with an NCQA program expert. Purchase and review the program resources, conduct a gap analysis and submit your online application.

Align your organization’s processes with the standards. NCQA conducts the survey and determines your Accreditation status within 30 days of the final review.

See a step-by-step process.

How much does Population Health Program Accreditation cost?

Pricing is based on multiple factors. Submit a request through My NCQA to obtain full pricing information.

How long does it take to earn Population Health Program Accreditation?

The typical evaluation time frame is 12 months from application submission to decision, depending on an organization’s readiness. Some organizations may already be working within NCQA guidelines, so the timeline will be shorter.

How do I get started?

If you are not currently accredited and want to learn more, contact NCQA. If you have a current accreditation and want to talk to someone about your status or about renewing or adding accreditations, submit a question through My NCQA.

Where can I find information to help me get started?

• Accreditation Process and Timeline: Key steps, timing and resources for a successful accreditation process.
• Standards and Guidelines: The complete standards and guidelines, including the intent and scope of review.
• Interactive Survey Tool: Contains the complete standards and guidelines; you can also determine your organization’s survey readiness—the tool calculates your potential survey score.

What organizations have earned Population Health Program Accreditation?

See the NCQA Report Card for a directory of Accredited organizations.