Transcript VISN 5 Trends - The Mihalik Group

Changes to NCQA Health Plan
Accreditation for 2009
Gary J. Mihalik, MD, MBA
The Mihalik Group, LLC
1300 W. Belmont #500
Chicago, IL 60657
www.themihalikgroup.com
Objective
 To
highlight the most significant
changes to NCQA’s Health Plan
Accreditation Standards for 2009
General Observations: HPA 2009
No new standards added
 No standards removed
 Most changes are “clarifications” although
some are significant
 Standards now constitute 57 out of the 100
points used to determine accreditation status


Down from 61.3 points in 2008
QI 9: Clinical Practice Guidelines
QI 9A: CPGs must be in place 24 months or
longer at time of survey
 This will require that the process for review
and update, specified in Factor 3, be
implemented

MEM 1: Health Risk Appraisals
MEM 1F: HRA must be available by a means
other than on-line
 Printed HRAs must contain the same content
as the web-based version, including followup resources

MEM 4: Pharmacy Benefit Info

MEM 4A and 4B: Use of a PBM is
considered delegation
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
All requirements of MEM 9 (Delegation) apply
MEM 4C: Quality improvement process must
address all 8 factors of MEM 4A and 4B
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This is one of the most significant changes
Scope of QI process was previously unspecified
Now 16 different measures are required
MEM 5: Health Plan Services

MEM 5A: Use of email to request an ID
Card or PCP change does not meet
requirement to complete these actions in one
attempt or session via the web
MEM 6: Innovations in Service

MEM 6A: Two new ways to provide online
personal health records:

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Allowing members to track personal health
information on a “sheet” accessible through the
health plan’s web site
Providing a link from the health plan’s web site
to a free online personal health record and
encouraging members to access it
MEM 7: Health Information Line

MEM 7A: Access to health information line
by email has been clarified

It is acceptable to use a non-email web-based
messaging system rather than traditional email
Just a note…
Although these are the most significant
changes there are others
 Remember to check NCQA’s website for
periodic updates
 If you need accreditation-related help,
contact The Mihalik Group
