The National Committee for Quality Assurance (NCQA) is including population health management (PHM) as a new category in its 2018 Health Plan Accreditation (HPA) standards and guidelines. The PHM category is a shift from evaluation of single-disease state toward a whole-person focus, NCQA says.

Within the PHM category, health plans must describe their strategy for addressing the needs of members, then demonstrate effective execution of that strategy.

The updated standards combine components of PHM such as wellness and complex case management, which were long-standing NCQA Accreditation requirements. The new PHM category also recognizes the important role of data analytics for identifying population needs, targeting resources to the right individuals and evaluating the impact of their strategy. This holistic approach allows removal of a number of outdated standards, such as siloed disease management and practice guidelines. Changes resulted in a net reduction of seven elements.

“NCQA recognizes the need for a population health focus on care management in which plans evaluate their membership and connect them to the care they need,” the group said in a statement announcing the new category. “NCQA encourages aligning with the delivery system including accountable care entities, practitioners, and patient-centered medical homes to meet population heath goals.”

More information on the NCQA health plan accreditation requirements is available online at: