Explaining NCQA Health Plan Accreditation (HPA) Series
Explaining NCQA Health Plan Accreditation (HPA) Series
This webinar series provides thorough explanations of HPA Standards for Credentialing (CR), Delegation (DEL), Member Experience (ME), Network Management (NET), Population Health Management (PHM), Quality Management & Improvement (QI), and Utilization Management (UM). Through these recorded presentations, faculty equips learners with guidance for interpreting the requirements, navigating the standards, and avoiding common misconceptions. In addition to these explanations, scenarios, short activities, and polling questions are included to simulate applied examples. Q&A from live sessions are also included for learner references. This series has approximately 30 hours of recorded presentation and material.
Note: This training covers HPA Standards for surveys conducted between July 1, 2020 and July 1, 2021.
- Administrators and Clinicians
- Consultants, Contractors, and Vendors
- Directors, Managers, Specialists, and Coordinators
- Professionals at Health Plans or Managed Care Organizations
- Professionals of Credentialing or Provider Relations
- Professionals of Case, Utilization, or Care Management
- Professionals of Compliance, Regulation, or Public Policy
- Professionals of Population or Public Health
- Professionals of Performance, Quality, or Risk Management
Fundamentals of Health Plan Accreditation (HPA)
- Review how to read a standard.
- Explain Accreditation components and how they result in a status.
- Discuss core scoring and evaluation concepts.
- Describe how Health Plan Ratings are part of Accreditation.
Explaining HPA Standards
- Simplify the intent of Standards for Health Plan Accreditation (HPA).
- Evaluate data sources for compliance with HPA Standards.
- Describe relationships across Elements within HPA Standards.
- Critique practical scenarios for applied competencies.
- Clarify common misunderstandings of requirements.
- Discuss standard requirements appropriate for delegation.
Cindy Allen-Fedor, RN, MPA, CPHQ, ACM
Cindy Allen-Fedor has held a variety of positions in healthcare organizations. She served as an Executive Vice-President for an integrated health system. Her areas of responsibility included Quality Improvement, Case Management, Disease Management, Patient Safety, Credentialing, Accreditation and Regulatory Compliance. Cindy is a registered nurse and NCQA Surveyor. She is also a Certified Professional in Healthcare Quality (CPHQ) and an Accredited Case Manager (ACM).
Cindy became an independent consultant in 2012. Drawing on her extensive experience as a nurse and NCQA Surveyor, she provides a wide range of consulting services. She has successfully guided many organizations through preparation and achievement of NCQA-Accreditation and Certification. Cindy’s areas of expertise include knowledge and experience assessing, developing, and implementing: Utilization Management, Case Management, Population Health, Quality Improvement, Credentialing, Accreditation and Regulatory Compliance.
Catherine Gitimu, MBA, MS
Catherine Gitimu has been improving healthcare quality at NCQA for 20 years. She has extensive knowledge of NCQA Accreditation and Certification products. Over the years, she has held various positions and is currently a Senior Policy Manager in the Accreditation Policy Unit. In this position, she wears many hats including serving as the process lead for the annual update of Accreditation and Certification Standards and Guidelines, resolving complex onsite survey issues, providing expert opinion on complex standards’ interpretation questions and performing NCQA Accreditation and Certification surveys among others.
Catherine holds an MBA (Healthcare) from The George Washington University, Washington DC and an MS (Information Management) from Sheffield University, Sheffield, United Kingdom.
Clint Koenig, MD, MA, MSPH
Clint Koenig, MD, MA, MSPH is the senior Medical Director at OhioHealthy, a new system-based health plan in Columbus Ohio. He has served as State Medical Director in New Hampshire and Ohio. Other leadership roles include the Health Plan Regional Chief Medical Officer at Universal American, a government programs health management organization in Syracuse New York as well as the Director for Utilization Management at Monroe Plan for Medical Care, a healthcare management organization in Rochester, New York. In addition, Clint held Chief Medical Officer roles in Federally Qualified Health Centers and integrated delivery systems. Clint has been an NCQA surveyor for 10 years and surveys health plans, Patient Centered Medical Home, Special Needs Plans and Long-Term Services and Supports organizations.
Dr. Koenig received his MD from Albany Medical College in Albany, NY. He completed his residency in Family Medicine, from the University of Missouri. He also completed a fellowship at the University of Missouri, where he received master’s degrees in Public Health and Journalism.
Veronica Locke, MHSA
Veronica Locke is a consultant for The Mihalik Group, providing healthcare-related consulting services. Her areas of expertise include quality assessment and improvement; Credentialing; Delegation; Disease Management Accreditation/Certification; Population Health Management; Multicultural Health Care.
Veronica is the former Senior Manager of Accreditation Policy for the National Committee for Quality Assurance. She was actively involved in the development and maintenance of the standards and guidelines of NCQA's Accreditation and Certification programs, specifically Health Plan, Disease Management and Multicultural Health Care Distinction programs. As a member of the Policy team, one of her major responsibilities was to serve as a content champion when providing policy clarifications and trainings internally and externally.
Veronica received her Bachelor of Science Degree in Public Health from the University of Maryland. College Park and her Master of Health Systems Administration Degree from Georgetown University in Washington, DC.
Shelly M. Smith, RN, MN, CPHQ
Shelly Smith is an NCQA surveyor and recently retired owner and Managing Consultant of Health Value Solutions, LLC, an independent healthcare consulting firm based in Liberty Lake, Washington. She has extensive experience in the development and implementation of health plan quality programs, disease management program development, worksite wellness program implementation and development of provider health care quality measurement and pay for performance programs. Through collaborative communication, Shelly is a proven leader in the successful preparation for health plan NCQA accreditation both as a health plan leader and external consultant and has provided successful consultation and leadership in vendor, employer group and provider environments. Shelly brings over 30 years’ experience in the health care industry having held staff and leadership positions in both the hospital and health plan setting. She started her career as a registered nurse and spent 4 years working with cardiovascular medical, surgical and transplant patients.
After completing her Master’s degree, Shelly transitioned to administrative roles where she served for over 15 years as both the Quality Manager and later Director of Quality with Medical Service Corporation and Premera Blue Cross. In these roles she led 5 successful NCQA accreditation efforts including commercial, Medicaid and Medicare membership, maximized HEDIS results, developed physician pay-for-performance programs and implemented successful disease management and employer-based wellness programs. She formed Health Value Solutions in 2008 and has worked with numerous health plans and vendors throughout the United States to achieve successful NCQA accreditation/certification since that time. Shelly has been a surveyor for the National Committee for Quality Assurance (NCQA) since 1996. She has been faculty for Blue Cross Blue Shield Association NCQA training earlier in her career and served as faculty for NCQA Surveyor Update training, Intro to Accreditation and Advanced Accreditation seminars in recent years.
Ms. Smith holds a Masters’ Degree in Cardiovascular Physiological Nursing, a Bachelors’ degree in Nursing, and a National Certification in Healthcare Quality.
Frank H. Stelling, M.Ed, MPH
Mr. Stelling is a Senior Consultant with The Mihalik Group. Prior to joining the Mihalik Group, he was Assistant Director, Accreditation Policy at NCQA for 14 years. Mr. Stelling oversaw the Policy Clarification Support System (PCS), a web-based tool for customers to ask questions of Policy Accreditation staff concerning all NCQA Accreditation and Certification programs. He also directed all education efforts out of the Policy Accreditation unit. In addition, Mr. Stelling was the lead on all federal and state deeming activities, including the Medicare Deeming program.
Mr. Stelling is also an NCQA surveyor and has been part of survey teams for the accreditation of Health Plans, Managed Behavioral Health Organizations. Disease Management Organizations and other organizations for over 17 years. Mr. Stelling has over 40 years of experience in health care with focus on Preventive Services, Disease Management and Quality Improvement. Before joining NCQA, he held management positions with state and county health departments, hospitals, voluntary health organizations and a managed care organization.
Frank holds a Master of Education from the University of South Carolina and a Master of Public Health from the University of California, Berkeley.
In support of improving patient care, the National Committee for Quality Assurance is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), the American Nurses Credentialing Center (ANCC), the American Academy of Physician Assistants (AAPA), the American Psychological Association (APA), and the Association of Social Work Boards (ASWB) to provide Interprofessional Continuing Education for the healthcare team.
This activity was planned by and for the healthcare team, and learners will receive 25.0 Interprofessional Continuing Education (IPCE) credit for learning and change.
This educational activity is approved for: 25.0 AMA PRA Category 1 Credit TM, ANA CNE, APA, ACPE and ASWB ACE.
This webinar provides maintenance of certification credit (15.0 points) under "other" for PCMH CCEs. This is a non AMA PRA Category 1 CreditTM, ANA CNE, APA, ACPE and ASWB ACE activity.
The assigned universal program number(s): JA0004597-0000-20-045-H04-P. Upon successful completion of this program (attending the full session and completing a program evaluation), participants will access CPE Monitor on the ACPE website to locate and track their CPE statement of credit.
- 25.00 AAPA
- 25.00 ACPE
- 25.00 AMA PRA Category 1 Credit™
- 25.00 ANCC
- 25.00 APA
- 25.00 ASWB
- 25.00 IPCE
- 1.00 Participation
- 15.00 PCMH CCE