MHR Newsletter
Driving healthcare quality one NCQA accreditation at a time
2024 #5
May 15, 2024
By: Nancy Ross Bell
From SusanÂ
With Spring now upon us throughout the US, MHR is also springing into action with new offerings!
As a bonus to all our followers, we are hosting a complimentary webinar on May 17 from noon to 1:00 ET. Susan Moore will present MHR Looks Ahead to NCQA's Proposed Changes to the 2025 Standards. If adopted, some of the changes may require significant effort on your part. Register for this “heads-up” by visiting MHR’s Events page.
This month, we are featuring MHR’s Consultant, Monique Fields. Read about her work with MHR’s clients and her aspiration to become a Master Gardener!  We love that our consultants have such rich lives away from work where they can recharge and renew from the detailed work they do for our clients!
May is a month with many national observances, including National Nurses Week. During this time, we recognize all nurses and those who choose to improve health care through quality measurement and accreditation.
Remember to save November 1, 2024, for our client dinner at NCQA’s Health Innovation Summit in Nashville. We would love to see you there!
If you are not a current client, we invite you to schedule a Discovery Call. This is an opportunity to learn more about how we can support your organization and why we are the top choice for an NCQA Consultant because of our detailed review of the standards according to NCQA’s Policy area of how the standards should be interpreted along with most of the consultants being NCQA surveyors.
No client ever has an outcome worse than our review of documentation because of the rigorous review. That also means that no client has ever been denied or lost accreditation under our watch. Our clients score in the high 90s and only lose points when they have not met look-back periods due to business issues, have not retained MHR early enough to mitigate all risks, or consciously chose not to meet a requirement due to budgetary constraints.
Clients are always aware of potential risks prior to submitting their documentation if MHR has reviewed all of their documentation. We value organizations that want to partner with MHR’s Consultants, appreciate their expertise, and foster a culture of mutual respect.
As always, let me or your MHR Consultant know how we can guide you along your NCQA journey.
Susan K. Moore, President & CEO
GET EASY ACCESS TO MHR’s TOOLS & TRAININGÂ
We are ready! You can now purchase MHR’s proprietary tools, templates, and training sessions. From a list of all available items, clients and non-clients alike can let us know what they need, arrange payment, and receive their items or instructions on scheduling a training session.
If you are not using our tools and training now, stop the struggle with trying to maintain your own and risk not being compliant!Â
Our clients tell us our tools are among the best on the market, so we are making them available more broadly. Over the years, we have heard from clients how our templates, such as the ones used for analysis, gave them the steps to follow to ensure compliance, particularly when staff or organizations were new to NCQA Accreditation. Â
Also, clients who have overturn of staff, limited experience, or capability to write analytically use MHR to write their analyses and other documents using the MHR tools. In those cases, their tools are provided at a discount. Thereafter, you can use the analyses as a guide for the next analysis written by your staff, if desired, and have the confidence that all of the required areas are addressed.
All items are updated with the most recently available standards. For a limited time, if you purchase an item now (prior to the July 1 implementation of the 2024 standards) that is compliant with the 2024 standards, you will receive a 2025-compliant version at no additional cost. Â
MHR’s Consultants can help you decide what items and training may benefit you most. If you have questions, contact your MHR Consultant.
If you are not a client of MHR and would like assistance, please Contact us. We would be happy to help.
 If you are not a current client, please reach out to Susan to schedule a Discovery Call and learn how we guide organizations on their path to NCQA Accreditation. Â
 MHR CONSULTATION + TOOLS + TRAINING = NCQA SUCCESS
GET TO KNOW MORE ABOUT
MONIQUE D. FIELDS, BA
MHR Consultant, NCQA Surveyor, herbalist, and aspiring Master Gardener are a few of the titles that describe Monique Fields.
When joining MHR’s team of consultants in 2022, Monique brought over ten years of experience with NCQA. She now consults on NCQA Accreditations for Health Plans, MBHOs, Health Equity, and Credentialing, as well as NCQA Certifications for WHP and CVO.
What Monique enjoys most about working with MHR is her ability to work with a variety of clients across NCQA’s programs, each with unique needs and challenges, whom she can inspire to achieve and sustain their accreditation.
Like most individuals moving from a role within an organization to that of an independent consultant, Monique shifted her sights from “one way” of thinking to “zooming out” and looking at different ways to solve an issue while helping clients achieve compliance.
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Monique values working with her fellow consultants, who each have a wealth of knowledge and multi-faceted experience. She has learned “1,000 ways to slice the pie”, such as guiding clients in selecting measures to improve for QI3 and QI4 on continuity and coordination of care. This is but one of the benefits of choosing MHR due to the experience requirements for joining the team and all of their consulting nationwide on all products that NCQA accredits – except for PCMH.
Monique is passionate about helping consumers have a better experience with the healthcare delivery system, including their health plans. She invites clients to think differently about how things are done and enhance processes to improve the consumer experience. Monique believes that just because things have been done a certain way and passed muster, there is always room for evolution and improvement. This is a hallmark of a true quality professional!
When working with Monique, you can be assured that “behind the scenes,” she is helping to ensure your success by reviewing documentation, providing feedback, mapping out recommendations for a path forward, keeping an eye on look-back periods, looking ahead at annual requirements to ensure required timeframes are met, and assessing potential impacts to other standards, among other potential risks.
One of the most fulfilling parts of her experience as a consultant is witnessing a “lightbulb moment” when a client understands how to meet the requirements in a way that is authentic to their organization and improves how things are done. Translating NCQA requirements into practical applications reminds her of the early times when she considered a career as a teacher! Â
Spending time engaging in activities that are both sacred and satisfying to Monique helps her manage her work/life balance in her home state of New Jersey. She is in the process of launching an herbal brand and graduating from an herbalism apprenticeship this May. Then, in December, Monique will finish her training as a Master Gardener, on her way to fulfilling a dream goal to launch a holistic wellness center where Eastern and Western medicine will converge, with land to grow her herbs, fruits, and vegetables. Both help fill her cup and allow her creativity to shine!
Read more about Monique and our other Consultants on MHR’s website.
NEWS
MHR shares what we recently found interesting in the news.
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National Strategy for Suicide Prevention
Behavioral Providers Eligible for Joint Commission’s New Telehealth Accreditation
3 Trends to Watch in End-of-Life Care
Hospital Lobby Leverages Cyberattack to Push Their Agenda and Avoid Reform
A New Metric May Provide Insight Into Healthcare Disparities
FDA Launches Health Care At Home Initiative to Help Advance Health Equity
CMS, NCQA Delay Health Plan Quality Reporting Following Change Attack
Why the ACA Health Insurance Exchange is the Next Reimbursement Battle Ground
It’s Okay to Not Be Okay: Tips and Resources for Mental Health Awareness Month
 QUALITY INSIGHTS
We asked NCQA for you!
Read what NCQA’s Policy Clarification Support (PCS) advised when MHR posed a question about the Appropriate Handling of Appeals. UM 9 requires the organization to document follow-up activity. But what documentation is required if there is no associated activity? Â
UM 9 A1: Â Appropriate Handling of Appeals
 Q: What documentation regarding the substance of the appeal is required if there was no follow up activity associated with the appeal?
A: If there were no follow-up activities required or associated with the previous denial and none conducted or occurred before the current appeal, the organization is not required to provide a statement in the file in order to meet Factor 1.
We ask many questions like this on behalf of our clients to provide assurance on exactly what is needed to meet the requirements for those “gray” areas we frequently encounter in our consulting.
News from NCQA:
 Follow the links. Â
- We’ve Extended the Deadline for HEDIS Reporting (4/29/2024)
- What New OMB Rules on Race and Ethnicity Mean to You (4/30/2024)
- Policy Updates for Accreditation and Measurement (3/25/2024)
- Looking for NCQA’s Frequently Asked Questions?
- Report Cards (4/15/2024)
- NCQA Store
Keep updated with MHR’s Blogs!
If you haven’t read our recent blogs yet, you won’t want to miss these. Simply click on the links to our website.
- NCQA’s has proposed changes to the 2025 credentialing standards for delegation agreements and systems controls.
- If you are planning to submit a bid as a Special Needs Plan (SNP) for the CMS CY2026, read our latest blog on Models of Care, which includes a list of tips you will want to review.
- Is a merger, acquisition, or consolidation in your organization’s plan? If so, you should read this blog to learn how it may impact your NCQA Accreditation.
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UPCOMING INDUSTRY EVENTS
May 17, 2024
MHR’s Complimentary Webinar on NCQA’s Proposed Changes to the 2025 Standards – Register on our Events page Â
May 29-30, 2024
CMS Health Equity Conference
- Bethesda, MD/Virtual
June 2-4, 2024
RISE Qualipalooza 2024
- Atlanta
June 11-13, 2024
AHIP 2024
- Las Vegas, NV
August 9, 2024
MHR’s Client-Only Training – Save the Date
- Live Webinar
September 9-11, 2024
NAHQ Next 2024
- Virtual
September 24-26, 2024
AHIP: 2024 Consumer Experience and Digital Health Forum
- Nashville, TN
October 1-3, 2024
Rise: The 14th Annual HEDIS® & Quality Improvement Summit
- Las Vegas, NV
October 31-November 2, 2024 -Save the Date- MHR Client Dinner on 11/1
NCQA Health Innovation Summit 2024
- Nashville, TN
December 13, 2024
MHR’s Client-Only Training – Save the Date
- Live Webinar
 2025
October 13-15, 2025
NCQA Health Innovation Summit 2025
- San Diego, CA
CALENDAR OF OBSERVANCES
Have you made plans to increase awareness of these observances?
May
National Asian American, Native Hawaiian, and Pacific Islander (AANHPI) Heritage Month
National Hospital Week (May 12-18, 2024)
Osteoporosis Prevention and Detection Month
High Blood Pressure Education Month
June
Men’s Health Week (June 10-16, 2024)
National Cancer Survivors Day (June 2, 2024)
August
MHR was incorporated in 1991 and specializes in preparing organizations for all NCQA accreditation and certification products.
All MHR consultants were responsible for NCQA accreditation in their previous roles before joining MHR as an independent consultant. Most consultants are also NCQA surveyors and the majority are clinicians. Read more about How We Work!
We welcome hearing from you! Please get in touch with us.Â
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