The National Committee for Quality Assurance (NCQA), which has been accrediting health plans for over 20 years and provides ratings for plans that cover more than 136 million Americans, has introduced the new Population Health Management (PHM) category for 2018 to support the Triple Aim and transformation to value-based care.

The PHM standards build upon existing requirements for wellness and complex case management, but further enforce the shift from a single-disease state towards a whole-person focus, as well as better alignment with delivery systems. Several elements require robust data integration and population segmentation, which highlight the need for advanced analytics and data warehousing capabilities like those provided by SPH. Further, interactive contact with eligible members is required to inform them about PHM programs, necessitating the need for multi-channel member outreach options, which SPH has provided for more than two decades.

NCQA recognizes health plans may use vendor solutions and delegations to support their PHM programs, and SPH is well positioned to support many of the PHM standards and elements, such as patient engagement, data aggregation, and population segmentation. As a vendor already recognized by NCQA for PCMH pre-validation, SPH will also apply for pre-validation for PHM should this anticipated program be introduced.    

Following is a breakdown of the six PHM standards and the corresponding SPH service offerings that can support these standards.

NCQA PHM Standards    Supporting Solutions from SPH 
PHM 1: PHM Strategy    Multi-channel member outreach 
(Onsite Healthcare Call Center | Email | Mail) 

• Inform/contact members

PHM 2: Population Identification    SPH Nexus Platform and Population Care application 

• Claims- and EMR-based data acquisition and aggregation

• Multi-factor population segmentation

PHM 3: Delivery System Supports    SPH Nexus Platform and Population Care application 

• Timely care gap sharing with providers

PHM 4: Wellness and Prevention    Multi-channel member outreach 
(Onsite Healthcare Call Center | Email | Mail) 

• Member outreach – Health Appraisals

PHM 5: Complex Case Management    Case Management Member Experience Survey 

• Assess members’ experience with case management

PHM 6: PHM Impact    Member Experience Survey Results 

• Measuring effectiveness of PHM functions

“SPH Analytics already proudly serves more than a third of health plans in the US and is pleased to be able to continue our support of our clients’ regulatory and accreditation requirements. As the new NCQA PHM requirements cause health plans to bring together data and programs that look at quality as well as member engagement, SPH can play a unique role in combining all three aspects of the Triple Aim in one platform – quality, cost, and experience,” stated Suzanne Cogan, Chief Commercial Officer for SPH Analytics.

Cogan continued, “SPH has worked with healthcare organizations throughout the nation for 25 years, empowering health plans and providers to connect with members and patients through multiple outreach channels to measure and improve consumer experiences and perceptions. In addition, the SPH Nexus Platform also aggregates data from several other sources, including EHRs and claims, to deliver in-depth analytics and key insights which healthcare organizations can leverage in meaningful ways to improve performance, value, and health outcomes.”

SPH Analytics will demonstrate its NCQA PHM supporting solutions next week in Booth 226 at the 2018 HIMSS Annual Conference and Exhibition in Las Vegas, Nevada.