ABOUT THIS ON DEMAND TRAINING

EXPLAINING HEALTH PLAN ACCREDITATION 2023 SELF-PACED SERIES

NCQA Health Plan Accreditation is the only program in the industry that bases results on clinical performance and consumer experience (HEDIS® and CAHPS®).

Through these courses, faculty provides participants with insight to interpret the requirements, navigate the standards, and avoid misconceptions. In addition to answering live questions from participants, faculty addresses scenarios and examples based on performance improvement opportunities from prior NCQA surveys.

Please note: These course present information based on Health Plan Accreditation 2023 standard requirements that are released in July 2022. The scope of these courses apply directly to NCQA Accreditation Surveys conducted between July 1, 2023 and June 30, 2024.

Group Training?

To inquire about group training rates, complete our online form.

Key Topics

Network Management (NET) – Duration: 3 hours
Individual cost: $349

• Evaluating adequacy of networks.
• Conducting qualitative and quantitative analyses.
• Demonstrating timeliness for network decisions.
• Assessing out-of-network utilization.
• Measuring effectiveness of interventions.

Population Health Management (PHM) – Duration: 3 hours
Individual cost: $379

• Constructing a comprehensive PHM strategy.
• Assessing patient populations.
• Managing complex cases.
• Managing value-based payment arrangements.
• Assessing segmented or stratified populations.

Credentialing (CR) – Duration: 3 hours
Individual cost: $349

• System Controls for Credentialing. 
• Credentialing Committee and Oversight.
• Verification of Credentials.
• Ongoing Monitoring and Interventions. 
• Assessment of Organizational Providers.

Member Experience (ME) – Duration: 3 hours
Individual cost: $349

• Communicating benefits with clarity and accuracy.
• Distributing subscriber information.
• Measuring quality and accuracy of communications.
• Supporting members with benefit-related decisions.
• Improving survey readiness and performance.

Utilization Management (UM) – Duration: 4.5 hours
Individual cost: $399

• Controlling UM systems.
• Handling member appeals.
• Determining coverage and medical necessity.
• Administering denial notices.
• Improving survey readiness and performance.

Quality Management and Improvement (QI) – Duration: 3 hours
Individual cost: $349

• Planning, evaluating, and controlling QI interventions. 
• Incorporating contracted practitioners and providers into QI.
• Coordinating care across the network. 
• Measuring effectiveness of QI interventions.

Course Resources

• Presentation slides. 
• Recording of live session.
• Scenarios for applied learning.
• NCQA surveyor's perspective of the standards.
• IPCE Credits for physicians, nurses and pharmacists.

WHAT YOU WILL LEARN

• Interpret the intent of Health Plan Accreditation requirements for NET, PHM, CR, ME, UM and QI Standards.
• Describe relationships and themes across NET, PHM, CR, ME, UM and QI Standards.
• Recognize requirement implications and considerations for stakeholders.
• Define performance improvement opportunities.

By achieving these learning objectives, participants may experience the following operational efficacies as three to nine month post-participation outcomes:

• Increased productivity in prioritizing and planning interventions.
• Improved practices in monitoring issues and risks.
• Enhanced coordination in cross-functional efforts.
• Refined tactics in monitoring performance.

WHO SHOULD ATTEND

Clinicians, executives, managers, specialists, consultants, delegates and vendors who are employed or contracted by health plans with responsibilities pertaining to the scope of work listed below:

• Case Management.
• Compliance or Risk Management.
• Population Health Management of Public Health.
• Quality Assurance/Improvement or Performance Management.
• Contracts Management.
• Health Information Systems.

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.

 

Clint Koenig, MD, MSPH, MA

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.

He 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, New York. 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 a master’s degree in Public Health and Journalism.

Veronica Locke, MSHA

Veronica Locke, MHSA is a process consultant with the Health Care Service Corporation (HCSC) in Dallas, Texas. Prior to joining HCSC, Veronica was 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. 
She 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.

 

Joseph Stankaitis, MD, MPH 

Joseph A. Stankaitis, MD, MPH since 1997 has been the Chief Medical Officer of the Monroe Plan for Medical Care, an Individual Practice Association (founded in 1970) and healthcare management organization in Rochester, New York and the Chief Medical Officer of its safety-net health plan, YourCare Health Plan in Upstate and Western New York. He oversees all clinically-related activities for these organizations, including its Health and Recovery Plan (HARP) for the Seriously Mentally Ill. He is also the Principle Investigator for Monroe Plan’s SAMHSA Grant, “Addressing Buffalo’s Opioid Epidemic with Medication Assisted Treatment.”

He is a Fellow of the American College of Physicians, Fellow of the American Association for Physician Leadership and Clinical Associate Professor of Family Medicine at the University of Rochester School of Medicine and Dentistry. He is an active reviewer and past Chair of the Review Oversight Committee and current Chair of the Reconsideration Committee for the National Committee for Quality Assurance (NCQA). He is a member of the New York State Department of Health Medicaid Evidence-Based Benefits Review Advisory Committee. He is the President of the American Diabetes Association (ADA) Rochester Volunteer Leadership Board and has served as a member of the ADA’s National Professional Practice Committee (develops national practice guidelines for diabetes care).

Dr. Stankaitis received a bachelor’s degree in biology from Boston College, his MD from the University of Connecticut and completed his residency and chief residency in the Primary Care Program in Internal Medicine at the University of Rochester. As a Kellogg Foundation Fellow at Harvard University, he received a Master’s degree in Health Policy and Management.

 

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. He holds a Master of Education from the University of South Carolina and a Master of Public Health from the University of California, Berkeley.

 

CONTINUING EDUCATION

The Credits listed below will be provided at the individual Course Level.

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) to provide Interprofessional Continuing Education for the healthcare team. 

Explaining Health Plan Accreditation 2022: Network Management (NET)

This activity was planned by and for the healthcare team, and learners will receive 3.0 Interprofessional Continuing Education (IPCE) credit for learning and change.

This educational activity is approved for: 3.0 AMA PRA Category 1™ and ACPE.

This educational activity is approved for 3.0 nursing contact hours.*

The assigned universal program number: . 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.

This live course grants 2.0 Continuing Education Unit (CEU) points for PCMH Certified Content Experts.  

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

Explaining Health Plan Accreditation 2022: Population Health Management (PHM)

This activity was planned by and for the healthcare team, and learners will receive 3.5 Interprofessional Continuing Education (IPCE) credit for learning and change.

This educational activity is approved for: 3.5 AMA PRA Category 1 CreditTM and ACPE.

This educational activity is approved for 3.5 nursing contact hours.*

The assigned universal program number: JA0004597-0000-22-009-L04-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.

This live webinar grants 2.0 other Continuing Education Unit (CEU) points for PCMH Certified Content Experts.  

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

 

Explaining Health Plan Accreditation 2022: Credentialing (CR)

This activity was planned by and for the healthcare team, and learners will receive 3.0 Interprofessional Continuing Education (IPCE) credit for learning and change. 

This educational activity is approved for: 3.0 AMA PRA Category 1 CreditTM and ACPE.

This educational activity is approved for 3.0 nursing contact hours.*

The assigned universal program number: JA0004597-0000-22-008-L04-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.

This live webinar grants 2.0 other Continuing Education Unit (CEU) points for PCMH Certified Content Experts.  

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

 

Explaining Health Plan Accreditation 2022: Member Experience (ME)

This activity was planned by and for the healthcare team, and learners will receive 3.0 Interprofessional Continuing Education (IPCE) credit for learning and change. 

This educational activity is approved for: 3.0 AMA PRA Category 1 CreditTM and ACPE.

This educational activity is approved for 3.0 nursing contact hours.*

The assigned universal program number: . 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.

This live webinar grants 2.0 other Continuing Education Unit (CEU) points for PCMH Certified Content Experts.  

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

 

Explaining Health Plan Accreditation 2022: Utilization Management (UM)

This activity was planned by and for the healthcare team, and learners will receive 4.0 Interprofessional Continuing Education (IPCE) credit for learning and change. 

This educational activity is approved for: 4.0 AMA PRA Category 1 CreditTM and ACPE.

This educational activity is approved for 4.0 nursing contact hours.*

The assigned universal program number: . 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.

This live webinar grants 2.0 other Continuing Education Unit (CEU) points for PCMH Certified Content Experts.  

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

 

Explaining Health Plan Accreditation 2022: Quality Management & Improvement (QI)

This activity was planned by and for the healthcare team, and learners will receive 3.0 Interprofessional Continuing Education (IPCE) credit for learning and change. 

This educational activity is approved for: 3.0 AMA PRA Category 1™ and ACPE.

This educational activity is approved for 3.0 nursing contact hours.*

The assigned universal program number: JA0004597-0000-22-010-L04-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.

This live webinar grants 2.0 other Continuing Education Unit (CEU) points for PCMH Certified Content Experts.  

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

NABP Credit Reporting 

If you are a pharmacist completing a course offering CPE credits, please notify NCQA through ncqa.org within 14 calendar days that you have completed a CPE course. You must provide the title of the course, your NABP identification number and your DOB (month/date) within the notification to NCQA. We also recommend you update your education.ncqa.org profile with your NABP identification number.  

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: None
Veronica Locke: None
Clint Koenig: None
Joseph Stankaitis: None
Frank Stelling: None 

Additional Planning Committee Members:
Vincent Pereira: None 
Felicia Khaalid: None 

This program was developed in part by NCQA staff.