Understanding NCQA’s Population Health IT Prevalidation Program

Is your organization an NCQA-accredited health plan, or a managed behavioral health, care management or population health vendor? Is your healthcare organization shopping for a new population health IT vendor? As part of HighPoint’s continued coverage of the new NCQA Population Health Standards, we want to take a closer look at population health IT vendors who have successfully achieved NCQA Population Health IT Prevalidation recognition.

If your healthcare organization is planning the selection process of purchasing a new population health IT platform, you’ll want to read further to learn about what it means to work with a vendor who has achieved NCQA’s IT Prevalidation recognition. This NCQA recognition demonstrates that the vendor’s product functionality supports or meets NCQA the standards required for that accreditation. Health IT systems/platforms that have achieved NCQA’s Population Health Management IT Prevalidation status, support NCQA accredited organizations with achieving and maintaining the Population Health Program Standards.

As of March 2019, there were four population health IT system/platform vendors with this designation: 1) Altruista Health for its Guiding Care version 8.7+ solution, 2) Medecision for its Aerial Insights and Aerial Complex Case Management solution, 3) SPH Analytics for MDinsight, and 4) ZeOmega for its Jiva, version 6.1+ solution.

Benefit to health plans

Population Health IT platforms that earn NCQA’s Prevalidation status support Health Plans by providing auto credit for specific Population Health Accreditation Standards. Health plans should consider Population Health Management Prevalidation if their IT solutions support:

  • Data Integration
  • Population assessment
  • Segmentation
  • Case management systems

Vendor advantages

IT prevalidation gives the population health IT vendor an advantage over its competitors that have not obtained NCQA prevalidation status.

These competitive advantages include:

  • Providing healthcare organizations with value-added benefits. Healthcare organizations using Health IT systems/platforms that meet NCQA requirements earn prevalidated credit. This eases the administrative and time required for submitting supporting documentation.
  • Gaining an edge on the competition. Population Health IT vendors can advertise that they meet health IT functionality established by NCQA PCMH requirements.
  • Extensive industry resources. Clients enjoy an ongoing collaborative relationship with NCQA and learn frontline details about planned policy changes and enhancements to PCMH recognition program requirements.
  • Receiving marketing support. NCQA lists prevalidated IT vendors on NCQA’s website

Prevalidation status

Health IT vendors with a technology solution that fully or partially meet PCMH criteria can submit documentation to NCQA about their solution’s functionality. The vendor and the NCQA Prevalidation team then performs a review of the solution via an application process and virtual review of the platform.

NCQA determines if the solution is eligible to earn IT prevalidation status, and which core and/or elective credits are granted.

IT vendors pay an annual maintenance fee to maintain their IT prevalidation status. Prevalidated vendors must inform NCQA of the following:

  • Changes in system functionality/versions. Note that IT prevalidation is for a specific version of the vendors technology. Subsequent versions in the vendor’s software must be reevaluated to achieve/maintain prevalidation accreditation.
  • Changes in an organization’s ownership.
  • Changes in address or contact information for NCQA and in the vendor directory.
  • Notice of any legal issues that may arise.

IT prevalidation

HighPoint Solutions assists health plans who are selecting a new population health system. HighPoint consultants are aware of the functionality of the Health IT vendors in the care management industry. One key requirement for health plans is Health IT prevalidation accreditation.

When working with clients, HighPoint reviews their business and technical needs. We consider the various population health systems available and evaluate the vendors capabilities to meet the client’s needs. HighPoint evaluates all the population health IT vendors in terms of automated authorization adjudication capabilities, interoperability/integration, correspondence management, comprehensive population health functionality/features, member and user details, Appeals & Grievances, Accreditation, reporting, etc.

Knowing the prevalidated IT vendor’s strengths and weaknesses, HighPoint can give an unbiased opinion of each prevalidated vendor. This assists the Health Plans in making the care management system selection.

To learn more about the HighPoint Population Health practice and what we can do to help organizations seeking a new population health vendor, please reach out to Chris McShanag, vice president, population health.