Quality & Accreditation Services

The world of healthcare quality is advancing. HMA keeps you ahead of the curve.

State and federal entities are relying more on independent measures of health plan quality to compare Medicare and Medicaid managed care organizations (MCOs). These measures are now linked to billions of dollars in performance revenue.

HMA’s quality and accreditation services can help you leverage these quality measures to maximize value-based contracts, win requests for proposals, increase membership, and optimize member experience.

The HMA approach to quality.

HMA’s quality solutions are tailored to the unique needs of our clients, and emphasize four key areas:

  1. Accreditation and Regulatory Performance: States are increasingly looking to accreditation programs to hold health plans accountable for the standards in which they deliver care. HMA’s Survey Ready Model will prepare you for the accreditation process–and keep your organization achieving accreditation standards every day.
  2. Clinical Quality Measurements: We’ll help you navigate key measurement systems such as HEDIS® and state-specific quality measures.
  3. Member Experience and CAHPS®: Increasing weight is being put on the member experience of care through surveys such as CAHPS and HOS. HMA can show you how to improve and optimize the member experience using a data-driven approach.
  4. Quality Performance Programs: Using our vast experience in the Medicare and Medicaid space, HMA can help you maximize ratings in programs like Medicare STARS and Medicaid quality performance.

HMA can support multiple projects and engagements within the quality space, from short-term to long-term needs, including temporary staffing, if requested. To learn more about our quality approach, contact our experts.

Meet some of our quality and accreditation experts.

Our experts in the quality space come from a variety of backgrounds including: National Committee for Quality Assurance (NCQA) surveyors, former HEDIS auditors, health plan and provider senior quality staff (vice presidents and chief quality officers), and former Medicare/Medicaid leaders.

Their in-depth experience allows them to understand the complex quality improvement needs of healthcare entities.

Accreditation: The HMA Survey Ready Model.

At HMA, we believe accreditation standards represent how an organization should do business every day, creating a culture of quality that will lower costs while improving care for members.

Toward this end, we use our industry-leading Survey Ready approach to help clients obtain accreditation, implement transformational change, and stay competitive.

Our accreditation experts give you a competitive edge.

HMA’s accreditation experts work alongside commercial, Medicare and Medicaid health plans every step of the way, from determining the right accreditation for your organization to achieving a successful outcome. Whether you are seeking AAAHC, NCQA, TJC, or URAC accreditation, or other certifications or distinctions, our experts’ insights and in-depth knowledge of the accreditation process will give you an edge that leads to better ratings – and more business.

Utilizing our Survey Ready Model, we’ll help your organization stay survey-ready year-round.

Our expertise:

NCQA

Overall NCQA plan accreditation, including Long-Term Services and Supports (LTSS), Health Equity, and Health Equity Accreditation Plus

AAAHC

AAAHC accreditation for health plans, Qualified Health Plans (QHPs), and the Federal Employees Health Benefits (FEHB) program

The Joint Commission

The Joint Commission (TJC) accreditation and certification for hospitals, ambulatory health, Federally Qualified Health Centers (FQHCs), Ambulatory Surgical Center (ASCs), and behavioral health.

URAC

URAC accreditation for dental plans, Medicaid or Medicare health plans, and Pharmacy Benefit Management Plans (PBM)

Member experience and CAHPS scores: Optimizing the journey.

HMA tailors solutions to address member experience and CAHPS improvement, based on the unique demographic and social characteristics of the populations being served.

We take a strategic and data-driven approach to CAHPS improvement initiatives, developing a “CAHPS game plan” that can be used to continuously improve performance while creating actionable data. This plan will spur incremental year-over-year changes in member experience measures.

CAHPS improvement services:

  • Creating an annual CAHPS improvement roadmap/game plan
  • Mapping the member journey and experience
  • Analyzing keys factors such as grievances, access to care, and other barriers to member satisfaction calculating ROI tied to the overall experience of care
  • Improving plans around member engagement and satisfaction
  • Developing a data driven model to track member experience year around
  • Survey set-up and audit support
  • In-depth review of CAHPS questions and composites

Clinical Quality Measurements: Maximizing HEDIS and other ratings.

Navigating changing requirements for health plans can be challenging. There are now multiple quality measurement systems, including:

  • HEDIS
  • CMS Medicare Star Ratings
  • NCQA Star Ratings
  • Marketplace Star Ratings
  • Other state-/federal-based performance incentives and initiatives focused on clinical outcomes and performance-based standards

HMA’s approach drives improvement in these critical measures using four core strategies:

  • Data/Analytics
  • Organizational Alignment
  • Member Interventions
  • Provider Interventions

By designing strategic initiatives across these broad areas, HMA has had significant success in helping health plans, vendors, and providers achieve year-over-year results in HEDIS and other clinical measurement improvement in core quality metrics.

HMA consultants are professional and hard working. They are constantly trying to add value wherever they can. Absolutely outstanding across the board.

– Current HMA Client

Quality and accreditation insights

Devising a framework for non-profit fundraising

Money is always “top-of-mind” among non-profit leaders, from CEO’s at Federally Qualified Health Centers (FQHCs) to Executive Directors at Community-based …

Using Virtual Research Data Center (VRDC) Data to Answer Big Questions

Health Management Associates (HMA) is utilizing Virtual Research Data Center (VRDC) data to do what HMA does best: solve publicly …

Consumer Assessment of Healthcare Providers Systems (CAHPS): Improving Member Experience

Medicare and Medicaid plans are faced with a barrage of regulations, including quality rankings. To improve rankings plans can, and …

HMA Can Help You Prepare for The Joint Commission (TJC) Accreditation and Certification

HMA’s team of experts have completed accreditation requirements with our clients as well as in our formal executive and operational …

Mary Walter talks depth and breadth of HMA experts working to achieve health equity

HMA Principal Mary Walter discusses the depth and breadth of HMA experts working together to achieve health equity. March 2023.

Mary Walter talks quality and accreditation client success stories

HMA Principal Mary Walter shares HMA quality and accreditation client success stories. March 2023

Mary Walter talks the importance of quality in achieving market viability and financial sustainability for organizations

HMA Principal Mary Walter shares the importance of quality in achieving market viability and financial sustainability for organizations. March 2023.

Mary Walter talks how HMA’s survey ready model and other quality assessments can evaluate a quality organization’s needs

HMA Principal Mary Walter shares how HMA’s survey ready model and other quality assessments can evaluate a quality organization’s needs. March 2023.

Robin Trush talks how HMA can assist provider clients in leveraging technology to improve their quality improvement programs

HMA Principal Robin Trush shares how HMA can assist provider clients in leveraging technology to improve their quality improvement programs. March 2023.

Caprice Knapp talks current challenges to state Medicaid programs

HMA Principal Caprice Knapp discusses current challenges to state Medicaid programs. March 2023.

Caprice Knapp talks SDOH barriers payers and providers are facing to address health related social needs

HMA Principal Caprice Knapp discusses the social determinants of health barriers payers and providers are facing to address health related social needs. March 2023.

Ready to talk to an expert about your quality and accreditation project?

Schedule a Consultation