health-plans

Health Plans
Case Studies

NCQA Accreditation

Summary

Our team used its expertise in accreditation processes to help a professional health assistant case management company match its organizational accountability, quality measurement and compliance standards to what was expected by the NCQA accreditation body
 

Challenge

  • An organization providing professional health assistant case management services to large employers, health plans and health systems was seeking accreditation to enhance it’s competitiveness in the marketplace
  • This company needed consulting support with expertise in accreditation processes and standards for NCQA to manage the project
  • This company was seeking external guidance for a path to clear organizational accountability, quality measurement and compliance to standards as expected by the NCQA accreditation body, in order for the organization to be fully prepared for a successful accreditation process

Approach

  • We performed an assessment to identify the gaps for NCQA case management accreditation standards against the company’s current documented processes, organizational structure and utilized system applications
  • We identified and developed a plan to address identified gaps for organizational processes, organizational structures and suggested system application enhancements to successfully achieve accreditation
  • We reviewed the entire NCQA accreditation process with senior leadership as well as department SMEs
  • We assisted the client in the creation and organization of all documentation needed for the audit and loaded this information into the NCQA Survey Tool

Results

  • We assisted the client in creating and revising organizational processes, policies and procedures for both the case management and disease management programs to ensure readiness for the NCQA audit process
  • A gap analysis for both case management and disease management was completed based on the associated NCQA standards
  • A roadmap was created for both case management and disease management to for the client’s use in order to close all gaps identified
  • A “mock audit” was conducted and results were reported, which included additional feedback to the staff that would enable the client to prepare appropriately for the NCQA audit