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Population Health Program Accreditation Standards

NCQA Population Health Program Accreditation evaluates organizations’ programs against industry best practices for population health management. Eligible programs must be person-centered and may be population- or condition-specific. Organizations must meet program criteria to pursue this Accreditation.

Focus Areas to ensure high quality

NCQA Population Health Program Accreditation requirements ensure that organizations align their operations with population health management best practices, improving management of individuals with complex needs and adding efficiency. Requirements cover these key areas:

  • Data integration.
  • Population assessment.
  • Population segmentation.
  • Targeted interventions.
  • Practitioner support.
  • Measurement and quality improvement.

Eligible programs must be person-centered. These programs are condition or population-based and may:

  • Address a single disease or condition (e.g., diabetes, asthma, high-risk pregnancy), or
  • Address multiple conditions to manage specific risk factors in a targeted population (e.g., reduction of inpatient admissions for ambulatory-sensitive conditions).

Get the Standards & Guidelines document to see all program requirements.

REQUIRED ORGANIZATION SERVICES

Standards are designed for organizations performing population health management functions that include data integration, population assessment, population segmentation and targeted interventions; for example:

  • Population health management organizations.
  • Disease management organizations.
  • Health plans.
  • MBHOs.
  • Provider organizations, including medical groups, hospitals and integrated delivery systems.
  • Pharmaceutical companies and PBMs.

IS MY ORGANIZATION ELIGIBLE?

Population Health Program Accreditation is for organizations that:

  • Perform functions covered in the Accreditation program or arrange for functions to be performed, directly or through a service agreement.
  • Manage enough members to constitute a valid sample for NCQA evaluation (where standards require patient file review).
  • Have population health programs in operation for a minimum of 6 months when the application and contract are submitted.

POPULATION HEALTH PROGRAM ACCREDITATION SUPPORT

Find information about NCQA Population Health Program Accreditation here:

  • Standards and Guidelines: The complete standards and guidelines, including the intent and the scope of review.
  • Interactive Survey Tool: Contains the complete standards and guidelines; you can also determine your organization’s survey readiness—the tool calculates your potential survey score.
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