Case Studies

MHR Case Studies.

Managed Healthcare Resources has successfully been helping clients through the NCQA accreditation for over 30 years.

Our clients love our small boutique consulting firm because of our collaboration with our clients and within our team. We provide a flexible approach that fits your unique needs.

But, don't just take our word for it, let's look at some successful case studies.

Case Study 1: A Medicaid Plan with Great Complexity

MHR had taken a Medicaid plan through accreditation for a First Survey previously. Because they did not have seasoned accreditation staff, MHR consultants mentored the staff to successfully achieve 100% on the survey. This included a readiness assessment for a baseline, documentation review and development, data identification for report development, analysis writing, periodic file reviews for medical management, case management, and appeals, document preparation for the file review, file universe development, and file preparation for the survey.

Case Study 2: Potential Client Did Not Listen

Recently an organization asked for a proposal, and MHR was one of the three finalists. Two of the consulting organizations recommended a First Survey to be completed in less than 24 months after consulting started. This organization was a Medicaid/Medicare home and community-based organization that had been in business for 20 years, and now the State was mandating accreditation.

Case Study 3: A Managed Behavioral Health Organization in Crisis.

A managed behavioral health organization (MBHO) contacted MHR as the CEO had experience with MHR’s ability to put all-hands-on-deck to pull organizations through crisis periods, and this was a crisis as their survey was six weeks away. A team of MHR consultants reviewed all documents and conducted a file review. Many strategies and workgroup meetings were held to position the organization for the highest score

Case Study 4: Complex Situation with Delegation of Most Activities to External Organization

A health plan with almost 100% delegation to other entities, retained MHR for their First Survey. A different consultant was used for the Interim Survey. The contracting process took almost five months and was finally executed eight months prior to their survey. After the kickoff transition meeting between the MHR President and Lead Consultant/Project Manager (PM) and the accreditation lead for the Plan, there was basically radio silence.

Case Study 5: Inadequate Number and Inexperienced Staff

Organizations of all sizes can have difficulty preparing policies, procedures, reports, and materials that meet the NCQA standards and possibly regulatory requirements when preparing for an NCQA survey. This can happen due to staffing changes or shortages, a lack of prioritization of NCQA, or a lack of training. Expert guidance from MHR led to this health plan achieving 100% of points on scored standards.

Case Study 6: No Accountability for NCQA Can Lead to No Accreditation!

An organization that was unsure of who was accountable for NCQA, didn’t keep up with changes in the standards, and did not invest in staff training led to an “SOS” call to MHR. Just one month before submission, this organization was behind on completing many requirements, including those needed for delegated oversight during its look-back period. Without NCQA Accreditation, this organization would lose its clients who require this quality status.