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.
Jump ahead to:
- The HMA approach to quality
- Meet some of our quality and accreditation experts
- Accreditation: The HMA Survey Ready Model
- Member experience and CAHPS® scores: Optimizing the journey
- Clinical Quality Measurements: Maximizing HEDIS® and other ratings
- Optimizing Medicare Advantage Star ratings
- Read our latest quality and accreditation insights
The HMA approach to quality.
HMA’s quality solutions are tailored to the unique needs of our clients, and emphasize four key areas:
- 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.
- Clinical Quality Measurements: We’ll help you navigate key measurement systems such as HEDIS® and state-specific quality measures.
- 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.
- 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 the team ready to solve your organization’s complex challenges.
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.
Our accreditation experts give you a competitive edge.
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.
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.
NCQA
Overall NCQA plan accreditation, including Long-Term Services and Supports (LTSS), Health Equity, and Health Equity Accreditation Plus
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.
Digital Quality Measurement: A Key Driver to Value
A seismic shift is coming. Beginning in January 2027, new federal interoperability and prior authorization rules will require widespread data exchange, paving the way for full digital quality measurement (dQM). HMA, together with Leavitt Partners, an HMA Company, has front-seat knowledge into this complex transformation, and is actively influencing and shaping national conversations on interoperability and digital measures. Our unique federal insights and strategic consulting capabilities give you access to the latest best practices, regulatory updates, strategic guidance, implementation, and evaluation. We are leading health plans and provider groups in this process to navigate digital transformation efficiently and effectively.
Health plans and provider groups that act now to transform their quality programs will be best positioned to meet these mandates and gain competitive advantages in value-based care.
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.
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
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.
Optimizing Medicare Advantage Star ratings
HMA’s Acceleratory approach and solution drives continuous quality improvement in these critical measures using four core strategies:
- Organizational Alignment
- SWOT Analysis and Recommendations
- Data/Analytics
- Plan Preference and Plan Access
- Stratification, Co-Enrollment, Gap Support, Provider Support
- Measure Strategies, Digital Readiness, Analytics
- Member Journey Mapping and Experience
- Member/Provider/Vender/CBO Interventions and Outreach
Read more about our Stars Accelerator Playbook and how HMA can help your plan increase its rating.
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
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