Ask MHR About How to Get the Resources You Need When Budgeting for NCQA

By Nancy Ross Bell, RN

Estimated time to read: 5 minutes

Budget time is likely around the corner for many organizations, but it need not be painful when it comes to NCQA!  Know your organization’s goals and expected changes, assess your staffing, and ensure you have the right tools and training in place. If you are responsible for any part of NCQA, including subject matter experts (SMEs), Accreditation leaders, department directors, managers, or finance, this blog is for you to read!

What Are Your Organization’s Goals for NCQA?

First and foremost, organizational goals for NCQA must be established, shared, and verbalized with all staff and employees so that needs are identified and the appropriate resources are budgeted and obtained.

A first-time pursuit of NCQA Accreditation differs in intensity from a Renewal Survey, which requires higher levels of quality improvement and analysis and, thus, trained resources.

Are Structural Changes Expected that Can Impact a Budget?   

Structural changes impacting an organization could impact the costs of NCQA, including:

• mergers, acquisitions, or consolidations (MAC)
• new legal entities
• entrance into new states, geographic regions, or product lines

In a recent blog, we discussed how a MAC or Discretionary Survey may be necessary for mergers, acquisitions, or consolidations.

Is an M&A in Your Organization’s Future? Be Ready for What’s Next for Your NCQA Survey (May 6, 2024)

In some situations, organizations may be eligible for a Single Site Multiple Entity (SSME) survey, which can help streamline the administrative burden and costs.

Adding New Product Lines and Add-On Surveys Can Impact Your NCQA Budget

Additional fees for applications and files under review may apply with add-on surveys such as Health Equity or LTSS Distinction.   

Other Associated Costs

When adding new product lines or other surveys, consider internal development or operational costs for any of the following that could impact a budget.

• New programs and activities for population health management
• New delegation agreements requiring meetings and oversight audits
• Data feeds to/from delegates, vendors, and governmental programs
• Internal integration of data for analysis and reporting
• IT systems or software upgrades that support file reviews
• Website changes for member and provider information
• Required process changes identified by MHR or from your last survey
• Tools and templates used for documentation

Budgeting for NCQA and associated process changes can be overwhelming, but don’t let it be! MHR Consultants can help you streamline survey applications and prioritize expenses that bring the most value to your organization.   

The Right People Make the Difference

There’s no doubt that NCQA Accreditation is complex and impacts nearly an entire organization, which is why it’s imperative to have the right people in place.

Because MHR’s philosophy is to “teach people to fish and not fish for them,” we emphasize having the following:

• the right number and type of people in positions to handle the work
• the right people with the requisite knowledge and skills on the NCQA standards
• the right people who can easily access and apply tools that enable them to work efficiently and accurately

However, sometimes organizations struggle to have the right people in place.  When it comes to resources, we often hear two comments:

• We don’t have the right people to do the job
• I am expected to absorb the work of NCQA plus what I’m already doing

To help solve the right-people staffing dilemma, MHR developed a consultative process customized according to the type of NCQA program for which an organization is seeking Accreditation.

MHR’s Staffing Assessment

MHR’s Staffing Assessment is a process by which an MHR Consultant collaborates with the organization’s leaders to assess its current staffing resources and compare the results to what is estimated as needed to meet the NCQA survey requirements, which will determine the organization’s survey score.

Upon completion of a Staffing Assessment, the organization receives:

• An Executive Summary outlining a staffing proposal for the organization
• A table listing positions needed for a successful NCQA Accreditation implementation and sustainability
• Details of the standards for which work* is required

*Work required may include leading quality committees, developing documented processes, writing reports, implementing new quality programs, monitoring and analyzing data, overseeing delegates, and internally consulting on marketing materials or website information.

Of high value is that the MHR Consultant can work with the organization’s human resource or talent management leaders to create a budget-ready listing of resources specifying its internal job codes, titles, business units, departments, FTE status, and annual salary range.  

But that’s not all! If you nodded “yes” to any of the structural or organizational changes listed above, they can also impact staffing resources.  How? Here are some examples:

• High point and must-pass standards, including mock file audits and analyses after mergers or acquisitions, are a high-priority
• New staff resulting from mergers or acquisitions may need coaching on how NCQA standards are embedded in your operations
• Add-on surveys require an additional survey Application to complete
• New delegation agreements require preassessment and oversight
• New products/product lines require input on member, subscriber, and provider information
• New IT systems, system controls, or integration require audits for information integrity

All require having the right people in place!

Barriers to Budgeting NCQA Staffing Resources

We have observed two common barriers to budgeting for the right people for NCQA Accreditation. Some organizations perceive that:

• All NCQA standards are of equal intensity! Wrong!

Organizations must meet the requirements described in the Factors and Explanations and meet other considerations, such as the look-back period and Scope for the particular product line. (Refer to Appendix 1-Element Points and Policies & Procedures of the respective NCQA Standards for more detail on scoring.)

Varying work efforts and skill sets are needed to develop documented processes, conduct qualitative and quantitative analyses, write comprehensive reports, oversee delegates, facilitate committees, work with providers on surveys and network management strategies, advise IT on new data requirements, and the like.   

• Finding talent with NCQA expertise is easy! Wrong again!

If you’ve tried to hire individuals with in-depth NCQA expertise, you are likely to agree that this knowledge and skill set are not easy to find! Hiring new staff without NCQA expertise can take about 13 months to train and coach, considering quality measurement cycles, committee meetings, annual reports, etc. After approximately 13 months, ongoing education is needed.  

Invest in Upskilling Staff with the Right NCQA Training

It’s well-known that having the knowledge and skills to fulfill job responsibilities leads to enhanced outcomes, which means higher scores on your standards, higher health plan ratings, and the ability for organizations to market themselves as higher-quality performers.

If upskilling staff through targeted and timely training is not done, some unknowing executive may comment:

Can’t you just read the standards?

We’ve done it before!

It’s not in the budget!

Training for NCQA Accreditation can be overlooked if you don’t plan ahead. Depending upon the findings from your Staffing Assessment, training should be:

• Targeted to the right people: new employees, SMEs, management, etc.
• Just-in-Time
• Annual for all NCQA updates
• Ongoing as gaps present themselves

 For example:

• All new employees should receive the Basics of NCQA Accreditation
• Data analysts and accreditation specialists should receive training in Analysis at a time when they can apply the new skills
• All SMEs involved with NCQA should be trained annually on NCQA Standards Updates
• Case Management professionals should be trained in File Review audits to help ensure proper documentation
• Customer Service professionals should be trained in the Member Experience standards and documenting complaints

MHR’s series of Training programs fulfill all the training you need.  What makes our training preferred is:

• We already know your organization
• One session or course fee covers everyone in your organization
• You receive the training slides
• You have the opportunity to ask questions unique to your organization

Having the Right Tools Always Makes a Job Easier!

Whether you are assembling a bicycle, baking a cake, or painting a house, having the right tools makes the difference!  MHR’s library of proprietary tools and templates is exactly what you need to prepare for a survey.

We have the tools, guidelines, and templates for all the NCQA standards. You don’t have to develop and maintain your own. Ours are also customizable if you want to modify them, say, adding a column or row unique to your program.

For example:

Our Analysis guidelines and templates walk even the less seasoned individual through the steps required for qualitative and quantitative analysis so that all requirements are met. 

Our Delegation Suite includes checklists, letter templates, audit tools, summary reports, and guidelines for agreements.

Remember NCQA’s Annual Costs

Your budget is not complete without including costs for:

• HEDIS
• CAHPS and other surveys
• NCQA Standards
• Quality Compass

How can MHR assist?

Whether you are approaching an NCQA survey for the first time or are a seasoned organization with a number of NCQA Surveys to account for, you may still feel the angst around budget time, particularly with having the right staffing levels, proper training, and tools to do the job.  That’s where our expertise comes in. 

In addition, we can guide you in:

• Evaluating your survey options and the timing of your surveys to help minimize costs
• Strategizing to maximize possible automatic credit with delegates
• Tracking your application dates to avoid late fees
• Having conversations with finance executives to explain the value of NCQA and proper funding for resources
• Explaining how tools and training are used throughout an organization’s three-year Accreditation cycle

Call to Action:

• Call us now to schedule a consultation and Staffing Assessment
• Ask an MHR Consultant about tools and templates specific to your NCQA program

MHR follows a quality review process for all blogs. This blog on Budgeting for NCQA was written with input from Kimberly Carpenter-Petit.  Read more about Kimberly and our other Consultants at ManagedHealthcareResources.com/About Our Consultants.  

MHR: Driving healthcare quality one NCQA accreditation at a time

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