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.

Meet some of our quality and accreditation experts.

Our experts in the quality space come from a variety of backgrounds:

  • National Committee for Quality Assurance (NCQA) surveyors
  • Former HEDIS auditors
  • Health plan and provider senior quality staff (vice presidents and chief quality officers)
  • 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 NCQA, AAAHC 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:

  • Overall NCQA plan accreditation, including Long-Term Services and Supports (LTSS) accreditation and the NCQA Distinction in Multicultural Health Care
  • AAAHC accreditation for health plans, Qualified Health Plans (QHPs), and the Federal Employees Health Benefits (FEHB) program
  • URAC accreditation for dental plans, Medicaid or Medicare health plans, and Pharmacy Benefit Management Plans (PBM)

Accreditation Support Services:

  • Interim or initial accreditation support for first-time applicants
  • Maintenance for re-accreditation, cycle-based accreditation status
  • Review, evaluation, and strategy development for provisional accreditation status
  • Annual mock audits and file reviews, including scoring
  • Assistance in designing a Survey Ready Model
  • Operational and documentation support to create and update documented processes, materials, and reports for accreditation submission
  • Implementation of multi-state corporate health plan models into a “Single Entity, Multiple Site” Model
  • Identification of potential accreditation score improvement for standards, HEDIS, and Consumer Assessment of Healthcare Providers and Systems (CAHPS)
  • CMS Special Needs Plan Model of Care Support

Training Opportunities:

  • Annual training for new standards and/or measures
  • Detailed training on how to set up and maintain a Survey Ready Model
  • Semi-annual sessions outlining changes in accrediting body standards to ensure each business area is well versed in new requirements
  • Workshops that develop a population health management strategy and implementation approach
  • Staff training to reduce findings from the mock file audits prior to the required accreditation look-back period
Quality & Accreditation

Client Results

Accreditation
Association for
Ambulatory
Healthcare

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.

Our clinical measurement expertise:

  • HEDIS improvement strategies
  • Medicare Star Rating maximization
  • Aligning quality Medicare STAR and risk analytics to save costs
  • HEDIS roadmap support and development
  • Natural language processing for quality improvement reporting
  • Electronic Clinical Data Set measures (ECDS)
  • Digital measurement process and FHIR/QI Core support
  • Data aggregator validation and HIE support
  • Supplemental clinical data acquisitions and strategies
  • Value-based contracting and performance standards
  • Marketplace Star Rating
  • Quality RFP/procurement support
  • NCQA Star Rating improvement tactics
  • HEDIS data and medical record review audit support
  • Support with state Performance Improvement Projects (PIPs)
  • Chronic Care Improvement Program (CCIP) support

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

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

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