How to Make Meaningful Updates to Your NCQA Population Health Management Strategy

By Nancy Ross Bell, RN

Estimated time to read:  4 minutes

Did your Population Health Management (PHM) Strategy meet the needs of your members? Were your PHM activities and programs reflective of your populations?

Populations and cultures across the US are changing. Health Plans must look for new patterns of emerging risks, changes in health status, opportunities to improve health literacy, and safety issues affecting health outcomes.  

MHR has worked with numerous organizations on their PHM Strategy. Based on our consultants’ experience, we have developed best practices utilizing our tools, templates, guides, and training. In this blog, we share important insights into the PHM standards, whether you are new to PHM and just getting started or ready to analyze your findings and update your existing strategy.   

MHR has a comprehensive PHM Suite of tools, templates, and guides referenced in this blog. Please note that our insights below do not reference all NCQA’s PHM Standards. Always refer to NCQA’s latest version of the standards and/or ask your MHR Consultant for assistance.

For organizations that have already implemented their PHM Strategy, the next step is to evaluate its effectiveness, starting with an analysis of the strategy's goals. At the same time, begin your Population Assessment based on your organization’s most recent data to help inform your new strategy. 

Complete an Annual Population Assessment (PHM 2A, 2B; PHP 2A, 3A)

An annual Population Assessment is required to identify the needs of your members. This is when you study the characteristics of the multiple sub-populations to understand the various populations’ needs.  This allows your organization to determine the necessary structure and resources for the PHM Strategy. 

After you analyze all PHM Strategy goals within the PHM Strategy Effectiveness Analysis, compare your findings to the needs of your members identified within the Population Assessment. 

Within MHR’s PHM suite is a Population Assessment Guide that explains the NCQA standards, asks thought-provoking questions related to your data, and includes examples of measurement that can help you develop your documented processes, reports, and materials. Complimenting the Guide is a Population Assessment Template that provides organizations with the necessary structure to complete a comprehensive Population Assessment.

Are you aware of any external changes in population characteristics in your service areas? In addition to your organization's data on its membership, look externally for population insights, such as those found in the Centers for Disease Control and Prevention.

Remember that the Population Assessment must include all members of all product lines, including individuals in Administrative Services Only (ASO) groups.  All product lines may be included in one report.

Conducting a PHM Impact Analysis (PHM 6: A-D)

NCQA scores the PHM Strategy Effectiveness Analysis for each product line brought forward for accreditation.

To determine the effectiveness of your PHM Strategy, first analyze each clinical, cost/utilization, and experience goal stated in the strategy.

After completing your analysis, compare your results to your Population Assessment to determine if the programs and activities met the needs of your identified populations and sub-populations.

MHR’s 2024 PHM Strategy Impact Effectiveness Analysis tool provides multiple tables where you input your own data and analyze the results, barriers, and opportunities. Having all the information in one document helps keep you organized and enables the NCQA Surveyors to more easily review your documentation. (PHM 6: A-D)

Need help with Quantitative & Qualitative (Q&Q) analysis? Follow the links below to two of MHR’s previous blogs and ask your MHR Consultant about our templates and training on Analysis.  

• Getting to the Why with NCQA’s Qualitative Analysis
• NCQA Q&Q Analyses That Bring Results

Facilitate a Stakeholders Discussion (PHM 2: C, Factors 1-4)

Discuss your PHM Strategy Effectiveness Analysis and Population Assessment, focusing on the member needs identified among a broad array of stakeholders to provide insight into:

• why barriers may have occurred
• what opportunities exist
• recommendations on how to update the organization’s PHM Strategy.

Committee minutes must include the following:

• a review of your PHM activities
• programs and resources to address member needs
• updates to newly implemented and/or revised PHM activities, programs, and resources.

 MHR recommends presenting the Committee with the following:

• a comparison of current activities, programs, and resources correlated against identified members' needs
• a discussion on the delegate's effectiveness, if programs or activities were delegated.

Record minutes of all stakeholder discussions and use this information to update your new PHM Strategy.

Review and Update Your  PHM Strategy (PHM 1: A, B)

NCQA scores the PHM Strategy for each product line brought forward for accreditation.

Developing your organization’s first PHM Strategy requires significant resources. In most cases, your organization already has programs and activities for its members that can “fit” into its Strategy. Interventions must meet the identified needs of the membership who have qualified for programs within NCQA’s four areas of focus

• Keeping members healthy
• Managing members with emerging risk
• Patient safety or outcomes across settings
• Managing multiple chronic illnesses

Utilizing the decisions from the stakeholders' discussion, update the PHM Strategy. 

MHR recommends:

• Having a dedicated section calling out new or updated activities, programs, and/or resources, along with updates in the corresponding area of focus.
• Presenting your updated Strategy report to your oversight committees, such as Quality Improvement, Clinical Oversight, and Member Experience, for approval.
• Recording the details of all updates and/or new activities, programs, and resources for the PHM Strategy in the approved committee minutes

Using MHR’s PHM Strategy Guide, PHM Strategy Template, and PHM Strategies Catalogue Template provides detailed steps to follow for all Elements and Factors and removes some of the stress of deciphering requirements and questions about how to proceed or what to include. Data analysts and accreditation/quality staff alike will appreciate these!

Call to Action:     

• Ask us about our PHM Suite of tools, templates, and guides. One price includes all you need to comply with NCQA’s PHM Standards.
• Does your organization need training? Schedule training on Analysis or the PHM Standards by contacting us via the website or asking your MHR Consultant. 

MHR follows a quality review process for all blogs. This blog on Population Health Management was reviewed by Kimberly Carpenter Petit, who also helped develop the PHM Suite referenced here. Read more about Kim and the other MHR Consultants on our website.

Contact Susan K. Moore at SusanMoore@managedhealthcare resources

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