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.     

Lacking an infrastructure to support their survey process, MHR shifted into high gear to help this organization submit on time. Here is what we saw and how we remedied the situation.

• A significant lack of NCQA knowledge by management and staff resulted in the MHR Consultant wearing three hats: coach, NCQA Surveyor, and “employee.”
• With the need for heightened communication, MHR established a process for frequent check-ins and required prompt turnaround of documents, which at times was the same day.
• Because the organization lacked a shared drive or other means to share files, MHR showed it how to store files in its Interactive Review Tool (IRT) as a temporary stopgap before submission.
• Without the expertise in delegation oversight and analysis, MHR coached the team using its tools and templates for Delegation.
• Because there was no one person who identified as being accountable for NCQA and responsible for the survey process, the MHR Consultant worked with their executive leadership to explain what was needed.
• Since the organization had not purchased and kept current with the NCQA standards and FAQs from their First Survey to Renewal, MHR coached management on the need to budget for and maintain oversight.
• Having a team that lacked the skills and knowledge to process its survey led MHR to temporarily assume the employee role, including guiding the organization in responding to outstanding issues from the original survey submission.
• Without an organizational work plan to maintain accreditation, MHR provided a detailed action plan tool with an end-to-end timeline for one year after the survey to facilitate and provide a framework for ongoing readiness, where, if followed, it would prevent a future fire drill prior to the next submission.

What are the lessons learned?

• While MHR successfully helped this organization achieve its NCQA Accreditation, some points were lost on a report since the organization had ignored its look-back period when delegated oversight was necessary. This is not a situation that a consultant could remedy. Because of the consultant’s extensive and deep experience in NCQA accreditation, she was able to lead the organization in a stepwise fashion to recover as many points as possible for the submission.
• NCQA is a continuous process, and to keep your accreditation, you can’t stop. There is no “off” year.
• Organizations must have a designated executive leader accountable for NCQA and a lead person who manages the survey process.
• The executive leader should establish a cadence of oversight of the process every 1-2 months to ensure goals and deadlines are met.
• The NCQA lead and Subject Matter Experts must have the requisite knowledge, which entails training on their Accreditation product and supplemental training, such as Delegation and Analysis.