From the perspective of a newly appointed accreditation lead, the experience of embarking on her first NCQA survey was initially daunting.

She vividly recalls the moment she was handed a hefty volume of intricate health plan standards and directed to compile the necessary evidence for the upcoming survey and wondered how she could ever understand them, much less successfully pass a survey. Everything changed when she was introduced to the leadership of MHR, including their CEO and a skilled team of consultants. What initially felt overwhelming soon transformed into a sense of excitement.

This accreditation lead joined the organization during a crucial period, specifically while navigating the complexities of an NCQA Health Plan Accreditation (HPA) Renewal survey encompassing multiple product lines. Adding to the organization’s challenge was the introduction of new Population Health Management (PHM) standards. MHR partnered with the accreditation lead to navigate the complexities of the Renewal survey.

Understanding that many individuals may not be familiar with NCQA Accreditation standards, MHR deployed team training sessions tailored to the needs of the health plan. They began by interpreting the intent behind each standard set and breaking down its various components, including standards, elements, factors, explanations, documentation requirements, look-back periods, and scoring protocols. To support the new accreditation lead, MHR Consultants provided one-on-one coaching and suggested project management training to further enhance her organizational skills.

To gather a baseline assessment of the health plan’s evidence in meeting requirements, MHR utilized its proprietary Gap Assessment tool, which documented the organization’s documentation and process gaps.  The tool produced a prioritized list of required actions organized by factor level. This discovery process was crucial, as it provided the accreditation lead with a clear and detailed roadmap outlining what was necessary to fill the gaps, allowing her to effectively communicate responsibilities to her teams.

As MHR evaluated the evidence presented, they also scrutinized the quality of the organization’s reporting. In instances where they found that the organization fell short of meeting the standards or was inconsistent, the MHR Consultant suggested the use of MHR’s proprietary templates. The health plan recognized its inadequate documentation and opted to leverage MHR’s templates for more compliant and robust quantitative and qualitative analyses. The use of MHR's templates enabled the accreditation lead to have better oversight of accreditation processes and insight into the standards’ requirements and complexities.

Initially, the executive leaders of the health plan were concerned about their chances of passing the survey. Yet, thanks to MHR’s strategic interventions and guidance for the new accreditation lead, the health plan not only succeeded but thrived. The organization's proactive decision to engage with MHR before the commencement of the look-back period proved to be a wise investment, ensuring they were well-prepared for the forthcoming survey.

The results were impressive: the health plan achieved a successful Renewal survey outcome for its multiple product lines, with the added benefit of fostering continuous quality improvement practices and enhancing project management skills within their teams.

The accreditation lead, empowered by the knowledge and experience gained from her collaboration with MHR, advanced from a newbie to the role of compliance specialist, where she was entrusted with managing additional NCQA surveys, including Health Equity standards and survey that were new to the organization, a testament to the transformative impact of her journey.