New Accreditation Signals Population Health's Coming of Age

October 22, 2019

Population health is on the rise. It's a fast-growing industry, projected to expand 16% annually through 2025. In academic medical centers, there has been a rapid increase in new departments focused on population health. And now, it is the focus of a new National Committee on Quality Assurance (NCQA) accreditation program, set to replace the longstanding Disease Management program. Evolent recently became the first organization to earn NCQA's Population Health Program Accreditation. We asked Evolent Chief Nursing Executive Kate Rollins and Accreditation Manager Tammy Hewlett to give their perspective on this accomplishment, what it means to the field, and where they see population health moving in the future.

What does it mean to you that there is now an accreditation for population health?

Rollins: It's more proof that population health has arrived as a discipline. It's been a buzzword ever since I left nursing school, but there hasn't been consensus around what that meant. Some organizations might advertise themselves as having a population health solution, but they're delivering one or two pieces of the puzzle, such as a technology platform. With the new NCQA Accreditation, we now have a clear bar for what it takes to deliver a comprehensive program. How do you integrate data from various sources, then use it to identify high-risk patients? What programs are you running to intervene with specific groups of these patients? How do you engage providers? How do you track your outcomes? You need to have answers to these kinds of questions, and then back them up with documentation.  

What’s the benefit for a company to have this accreditation?

Hewlett: First, it gives its partners reassurance that the company brings rigor and high-quality standards to its population health work. Accreditation also alleviates the burden to health plan partners for their own NCQA Health Plan Accreditation. For example, when a health plan delegates certain activities to Evolent, the plan benefits from NCQA's prior review of Evolent programs. Evolent's accreditation will provide the health plan "auto-credit." The plan doesn't have the administrative burden of preparing and submitting certain required documentation to NCQA, and it won't be required to perform as much oversight of the work that Evolent performs on its behalf. As a result, there's less work for the health plan.

Why do you think Population Health is replacing Disease Management as an accreditation?  

Hewlett: It's emphasizing a more proactive, whole-person approach over a reactive one focused on specific health problems. In traditional disease management programs, you're targeting small groups within the population who are diagnosed with a certain condition, such as diabetes or asthma. We’re moving from this siloed approach to looking after entire populations across the full continuum of care and doing our best to intervene before members get seriously ill or go to the hospital. This includes looking at individuals beyond their condition and addressing important life factors that influence health, such as financial burdens, behavioral health issues and lack of housing or transportation. You can't follow-up with your doctor if you have no way to get there.

Rollins: Having two or three disease-focused programs and managing high-cost, high-utilization patients isn't going to fly anymore. And if you add on the need to operate in a value-based world, you will have to take care of other parts of the population that are impactable, including the pediatric population, women who are pregnant, those at end of life, and others. We have about 25 clinical programs at Evolent, which make it easier to develop a true population health strategy and manage the complexity of diverse populations while meeting state and regulatory requirements.

What’s the next step in the evolution of population health?

Rollins: The industry needs to move toward "precision population health"—applying the concepts of personalized medicine to the field. In personalized medicine, treatments are tailored to a patient's individual traits, like genetic profile. We can take a similar approach to population health. At Evolent, before we even outreach a patient, we understand their level of risk in various domains, past history, gaps in care, the medications they are taking, etc. With advanced analytics, we can use a multitude of data points to predict the best method to engage them and the level of support they will likely need. Patients who are motivated to change might agree to care management after a short phone call. Others may be more inclined to engage if their provider initiates the conversation and then hands off to a Care Advisor. Having this information in real time improves the patient's odds of success while at the same time helping us get the most from our care management resources. It's a win-win.

Previous Article
Four Signs Your Health Plan's Administrative Platform is Becoming Obsolete
Four Signs Your Health Plan's Administrative Platform is Becoming Obsolete

Cobbling together an administrative platform from various point solutions can produce IT headaches, hurt ca...

Next Article
Independent Physician ACOs Missed Out on More Than $200 Million from CMS: Here's Why
Independent Physician ACOs Missed Out on More Than $200 Million from CMS: Here's Why

An Evolent analysis looks at the additional savings that Accountable Care Organizations could reap by takin...