Explaining Health Plan Accreditation 2024 Self-Paced Series -

About

Self-paced Series
Expires: June 30, 2024

Through these courses, experienced presenters will provide learners with insight to interpret the requirements, navigate the standards, and avoid misconceptions.

About this Self-paced Series

Explaining Health Plan Accreditation 2024 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, experienced presenters will provide learners with insight to interpret the requirements, navigate the standards, and avoid misconceptions. In addition to answering live questions, presenters address scenarios and examples based on performance improvement opportunities from prior NCQA surveys.

Please note: These courses present information based on Health Plan Accreditation 2024 standard requirements that are released in July 2023. The scope of these courses apply directly to NCQA Accreditation Surveys conducted between July 1, 2024 and June 30, 2025.

Group Training?

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

Key Topics

Credentialing (CR) -

Individual cost: $349

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

Network Management (NET) -

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.

Delegation (DEL) -

Individual cost: $349

Delegation oversight.
Sub-Delegation.
Auto credit.
Corporate and family relationships.

Member Experience (ME) -

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) -

Individual cost: $395

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

Quality Management and Improvement (QI) -

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.

Population Health Management (PHM) -

Individual cost: $395

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

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.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).

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 or Public Health.
- Quality Assurance/Improvement or Performance Management.
- Contracts Management.
- Health Information Systems

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.

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.

Veronica Locke, MHSA

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

Dr. Stankaitis is the principal of JAS Healthcare Consulting, LLC. He previously served as the Chief Medical Officer of Highmark Wholecare, an MCO based in Pennsylvania serving individuals covered by Medicaid and Medicare product lines.

Prior to arriving at Highmark Wholecare, he was Chief Medical Officer of the Monroe Plan for Medical Care. During 2021 and early 2022, in response to the COVID-19 pandemic, he also served as a part-time Deputy Commissioner of Public Health for Monroe County (New York).

Before joining Monroe Plan, Dr. Stankaitis was Vice President, Client Support and Education and Chief Medical Officer for Equifax Analytical Services. He previously served as Lead Medical Director for Excellus BlueCross and BlueShield’s IPA-model HMO, and as the clinical lead for Excellus’ Xerox Corporation’s Blue Cross Health Systems Management entity.

Other professional experiences include serving as Physician Advisor to the HMO Group, a national consortium of staff and group model HMOs; and prior to that, as Co-Director of the Internal Medicine Division and Head of Community Medicine, The Genesee Hospital in Rochester, NY.

Dr. Stankaitis holds a BS degree in Biology from Boston College, an MD from the University of Connecticut School of Medicine and an MPH in Health Policy and Management from the Harvard TH Chan School of Public Health. He is board certified in Internal Medicine.

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.

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 2024: 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 a maximum of 3.0 AMA PRA Category 1 Credit™, 3.0 Nursing contact hours and 3.0 ACPE contact hours.

The assigned universal program number: JA0004597-0000-23-034-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.