ARE YOU STAFFED UP FOR YOUR NCQA SURVEY?

By Nancy Ross Bell, RN

Word count:  684

Estimated time to read:  3 minutes

Leaders know that resources are needed for NCQA Accreditation.  In some organizations, “all things NCQA” are assigned to the “lucky few.” In others, NCQA standards are embedded into the quality infrastructure and operationalized by proficient staff in their unique areas of expertise.    

To help organizations with the dilemma of staffing resources, MHR developed a new customizable Staffing Assessment tool to assess your current staffing, determine your immediate and future needs, and implement an action plan that syncs with your next NCQA survey.

The Process – Questions We Ask

What are your goals for NCQA?

• Will you add entities, product lines, or surveys, such as for Health Equity?
• Do you intend to increase your HEDIS Star Ratings?

Will you “shoot for the stars” and staff up to “fully meet” all standards?

• Have you planned for staff departures?
• Is leadership development factored into your staffing plan?

What work is required to meet your goals?

• Must new documents or projects be developed?
• Are resources available for delegation oversight, annual analyses, monitoring of files, editing policies, and support services?

What resources are available to onboard new practitioners?

• Are training programs specific to their roles, such as reviewing UM denials, tracking receipt dates, or providing input on new population health programs?
• Will new practitioners participate in or lead committees, such as quality, pharmaceutical management, or recredentialing?

 Is an organizational training plan in place?

• What is the plan to train up to meet goals and stay current with NCQA requirements?
• Will you meet your look-back periods and analyses with your current staff?

Are external resources needed?

• Who will train, coach, and mentor your teams?
• Is leadership training and ongoing support part of your plan?

What Are The Risks If You Do Nothing?  

Some organizations may choose not to pursue an objective staffing assessment.  Here are several risks to consider.

• The knowledge and skills of tenured staff can go “out the door,” and replacement staff are not available or trained to take over.
• Standards needing clinical interventions are not executed on time, and valuable points are lost.
• Communications and meetings with individuals external to the organization, such as delegates, can lag.
• You may miss training impacting file review performance or delay delegate oversight audits or timely evaluation of delegate reports.

Do we really need a staffing assessment?  Isn’t the work getting done somehow?

Even if all seems to be going well, ask yourself questions like these. 

Are we achieving our organization’s goals for NCQA?

Will the organization need to pursue additional NCQA accreditations, such as Health Equity, or for expansion into new Exchange or Medicaid markets in the next three-year cycle?

Are we timely with our look-back periods and annual analysis requirements?

Are reports and policies reviewed and updated as needed?

Is NCQA a “second job” for many staff?

Are staff stressed because they don’t have the knowledge or skills to fulfill the requirements and may resent more responsibilities added?

Is meeting NCQA requirements part of their job description and annual performance review?

Is executive leadership accountable for NCQA processes?

You worked hard to become NCQA Accredited.  Don’t be caught without the staffing resources needed to sustain it!

What Is Included in MHR’s Staffing Assessment?

An MHR consultant will assess your staffing needs with input from staff and leadership and a review of records, such as current staffing levels, a list of job titles, and position descriptions. The consultant reviews the NCQA-related job responsibilities and the time it would take to perform them successfully. At the conclusion, you will receive:

• An executive summary
• A detailed staffing assessment
• An action plan and timeline according to your survey
• A closing session with key participants
• A presentation for executive leadership

Call to Action:    

• Evaluate your staffing plan
• Determine if your resources are appropriate

This Blog was written with insights by Kim Carpenter Petit, an Independent Consultant with MHR.

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