NCQA

Want to be Survey Ready? We’re ready to help.

Competition for Medicaid managed care contracts and consolidation within the market have intensified. In response, states are relying more and more on independent measures of health plan quality, most specifically as measured by the National Committee for Quality Assurance (NCQA), to compare, rate and score various Medicaid managed care organizations (MCOs).

Clearly, NCQA accreditation ratings can make a significant difference in determining whether an MCO wins or retains a contract. HMA’s team of experts works alongside commercial, Medicare and Medicaid health plans to successfully prepare for and streamline the accreditation process, resulting in improved accreditation ratings. In turn, this can help MCOs compete at a higher level.

What We Do

Our team of NCQA experts will work side-by-side with you to create a Survey Ready Model tailored to your organizational needs. A strategic and proactive approach, this model helps identify steps you can take every day to ensure that quality is the responsibility of more than just one department — and that your organization maintains a survey-ready status year-round.

With a deep understanding of health plan needs and NCQA accreditation requirements, including the new 2020 NCQA standard survey changes, we are ready to help plans succeed through accreditation and training. The cornerstone of HMA’s NCQA services is our industry-leading Survey Ready Model.

We believe NCQA standards represent how a health plan should do business on a daily, ongoing basis, and should be a part of every employee’s job description. This will ultimately create a culture of quality that will substantially lower costs, both in dollars and personnel expenses, while improving care for members.

Big changes are coming to NCQA health plan accreditation in 2020, and HMA is ready to help. Our NCQA experts have assessed the new scoring methods and are uniquely poised to guide you through these changes and on to successful accreditation.

How We Help: Our Services

Accreditation Support Services:

  • Support for interim or initial accreditation for first-time NCQA cycles
  • Re-accreditation, cycle-based accreditation status
  • Review, evaluation and strategy development for provisional accreditation status
  • Annual mock audits and file reviews, including scoring
  • New NCQA population health management standard accreditation
  • Assistance in designing a Survey Ready Model
  • HEDIS direction and proactive strategy
  • Operational and documentation support to create and update documented processes, materials, and reports for NCQA submission
  • Implementation of multi-state corporate health plan models into a “Single Entity, Multiple Site” model that uses corporate policies for all state health plans to reduce the staff hours and number of documents needed to update each state location
  • Identification of potential accreditation score improvement for standards, HEDIS, and CAHPS
  • HEDIS roadmap review and development for submission

Training Opportunities

  • Annual measures training for new standards
  • Detailed training on how to set up a Survey Ready Model
  • Semi-annual sessions outlining changes in NCQA 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 NCQA look-back period.
  • New NCQA population health management standard training

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