Network Management for Health Plan Accreditation

About this Self-paced Training

Network Management for Health Plan Accreditation

This course navigates customers through the most recent updates and changes to Health Plan Accreditation’s Network Management standards. NCQA staff and surveyors provide insights on interpreting requirements and navigating standards, and clarify misconceptions. The presenters will address scenarios, give examples of performance improvement opportunities from prior NCQA surveys, and answer questions.

What You Will Learn

Course Topics

·       Availability of Practitioners

·       Accessibility of Services

·       Network Adequacy

·       Physician and Hospital Directories

Learning Objectives

After the course, learners will be able to:

·   Describe updates and changes to the standards and guidelines.

·   Interpret the intent of Health Plan Accreditation requirements.

·   Describe relationships and themes across requirements.

·   Recognize requirement implications and considerations for stakeholders.

·   Define performance improvement opportunities.

Learning Outcomes

After completing this course, learners will be able to:

·   Develop and maintain evidence-based program policies and procedures.

·   Prioritize performance improvement initiatives.

·   Implement reliable and valid practices for network management.

Who Should Attend

Clinicians, executives, managers, specialists, consultants, delegates, and vendors who are employed by or contract with health plans and have responsibilities related to network management, including:

·   Accreditation or Compliance

·   Clinical Social Work

· Population Health

·   Quality Improvement

Resources Included

• Live Q&A with an expert
• Recording of live presentations
• Knowledge check quizzes
• Presentation slides

Related Materials

Note: Two professionals from each organization that purchased the HPA Readiness Package will have access to this course and to the Fundamentals of Health Plan Accreditation course.

Organizations should seek the appropriate number of licenses for the e-pub. These are also available through the HPA Survey Readiness Package.

Faculty

Irv Koehler, RN, MBA, CPHQ, CPC

Irv Koehler is a health care quality consultant for the Koehler Quality Group, LLC. In this position, he is an NCQA administrative surveyor and provides consulting services to organizations evaluating and preparing for NCQA Accreditation/ Certification projects, risk adjustment validation for managed care organizations, education on quality improvement practices and outcome measure development and tracking.  

Mr. Koehler is also a registered nurse with active licensure in Florida and Tennessee, and certification in quality and medical coding. Previously, he was a quality improvement professional at AmeriHealth Caritas and BlueCross BlueShield of Tennessee.

Mr. Koehler has an MBA from the Florida Institute of Technology, a BS in Nursing from Florida Southern College, a BA in Psychology and an ADN from Purdue University.

Continuing Education

This live course grants 1.0 Continuing Education Unit (CEU) points for PCMH Certified Content Experts.

This is a non AMA PRA Category 1 Credit^TM, ANA CNE, ACPE activity.

* Please note – You must attend the entire program to be eligible for total number of contact hours.

Disclosure of Relevant Financial Relationships

The National Committee for Quality Assurance (NCQA) endorses the Standards of the Accreditation Council for Continuing Medical Education which specify that sponsors of continuing medical education activities and presenters at and planners for these activities disclose any relevant financial relationships either party might have with commercial companies whose products or services are discussed in educational presentations.

For sponsors, relevant financial relationships include large research grants, institutional agreements for joint initiatives, substantial gifts, or other relationships that benefit the institution.  For presenters or planning committee members, relevant financial relationships include the receipt of research grants from a commercial company, consultancies, honoraria, travel, or other benefits, or having a self-managed equity interest in a company; or having an immediate family member or partner with such a relationship.

Disclosure of a relationship is not intended to suggest or condone bias in any presentation but is made to provide participants with information that might be of potential importance to their evaluation of a presentation.

Relevant financial relationships exist with the following companies/organizations:

Faculty:

Irv Koehler

Additional Planning Committee Members:

Felicia Khaalid: None

Ricco Konrad: None

Joel Nellis: None

This program was developed in part by NCQA staff.

Event Type

1. Live Online