From Susan 

I’m hoping your summer vacations are well underway and you have weathered the storms we have seen in many states where our clients reside.

MHR continues to be busy onboarding new clients and welcoming their teams to our MHR Community. We are grateful to you for trusting MHR to guide you through your NCQA survey preparation.

Last month, I mentioned that MHR is in the process of welcoming new consultants to our team. Look for more information in the months ahead.

As we finish our new Tools/Templates/Training website page, please be sure to read about our File Review Audit Tools & File Review Prep Guides. Because file reviews are must-pass elements, we are featuring these first.

Please mark your calendar for Aug. 9 for our next client-only webinar. MHR Consultants will discuss NCQA Policy Changes and insights from their recent surveyor training. Registration is $400 per organization. Please click here to register 

If you are attending NCQA’s Health Innovation Summit in Nashville from Oct. 31-Nov. 2, be sure to save Nov. 1 for MHR’s client-only dinner.

This is a reminder for organizations planning to submit a CY 2026 Model of Care (MOC) to MHR for review. Please contact us before Aug. 31.

NEWS

You may not always have the time to scan the news, so we do it for you! Each month, we select articles that may be of interest to you for accreditation and healthcare quality.

HHS:  Proposed Physician Payment Rule Cuts Doc Pay But Strengthens Primary Care

2025 OPPS Proposed Rule is Out: CMS Pitches Policies to Reduce Maternal Mortality, Advance Health Equity, and Support Underserved Communities

Improving Payment Integrity and Reducing Abrasion

A Look at Medicaid and CHIP Eligibility, Enrollment, and Renewal Policies During the Unwinding of Continuous Enrollment and Beyond

Potential Inequities in Accessing Medicare Counseling

New Estimates Highlight Differences in Growth Between the U.S. Hispanic and Non-Hispanic Populations

States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model

Illinois Becomes 1^st State to Ban Prior Authorization for Inpatient Behavioral Care

Why Prior Authorization Could Become an AI “Arms Race”

 QUALITY INSIGHTS

We asked NCQA for you!

According to NCQA’s Report Card, as of July 18th, 7,407 Healthcare Practices earned the distinction of NCQA Recognized Patient-Centered Medical Home (PCMH). This number is significant because Health Plans may be able to fulfill some requirements for QI3 under the 2024 Health Plan Accreditation standards with initiatives supported through the PCMH.  Data collected on the PCMH’s that identify opportunities to improve patient movement between practitioners (QI 3A.1) or movement across settings (QI 3A.2) can be documented and utilized to meet the requirements. 

Here are the highlights of what MHR confirmed with NCQA.

• Data collected to identify relevant clinical issues and opportunities to improve coordination of medical care must reflect movement between practitioners (QI 3A.1) and movement across settings (QI 3A.2). Some, but not all HEDIS measures, meet the transition requirement. For example, HEDIS measures for child/adolescent immunizations do not show movement, while Plan All-Cause Readmissions (PCR) would.
• Opportunities identified (QI 3A. 4-7) and Actions (QI 3B. 1-3) taken must relate to the data collected. If HEDIS measures are used to identify relevant clinical issues and opportunities, then actions taken by the PCMH or the plan in collaboration with the PCMH must tie back to this data. For example, if PCR was identified as an opportunity for improvement, then a PCMH pay-for-performance incentive to reduce preventable readmission may be appropriate.
• Effectiveness of improvement activities (QI 3C. 1-3) must be evaluated through remeasurement and an assessment of the actions taken by the PCMH. The assessment requires a conclusion on the effect of the actions on the remeasure. In this example, the actions taken to reduce readmissions (HEDIS PCR) are evaluated for effectiveness.
  • Effectiveness is not measured by other support that an organization may have provided to a PCMH unless the supportive action of collaborating with a PCMH initiative is related to the data collected and opportunities identified in QI 3 A. (QI 3 B. Explanation)

The 2025 NCQA Standards for Health Plans will be published in August or September. Proposed changes to QI 3 & 4, effective with surveys as of July 1, 2025, will be published with the 2025 standards release.

If accepted as proposed, organizations will identify opportunities based on its most recent Health Plan Ratings scoresheet for each applicable product line, and document a plan of action to improve each rating, how and when progress will be monitored, and staff responsible for carrying out the actions. Effectiveness will be demonstrated through analysis of its HEDIS Health Plan Ratings measures.

Many organizations find the standards for continuity and coordination of care challenging. MHR Consultants can advise on MHR’s Analysis Templates, Tracking Tools, and Data Collection and Methodology Guides specific to QI 3 & 4. As standards change, all templates, tools, and guides are updated.

UPCOMING INDUSTRY EVENTS

August 9, 2024
MHR’s Client-Only Training –Click to register.

• Live Webinar -Policy Changes & Surveyor Training Insights

August 13-14, 2024
Rise: Bedrock of Healthcare Virtual Training Series (Quality)

August 20-21, 2024
Rise: Bedrock of Healthcare Virtual Training Series (SDoH)

September 9-11, 2024
NAHQ Next 2024

• Virtual

September 24-26, 2024
AHIP: 2024 Consumer Experience and Digital Health Reform

• Nashville, TN

September 27, 2024 - Save the Date
MHR’s Complimentary Webinar

• Live Webinar - Health Equity Accreditation Plus-Common Challenges

October 1-3, 2024
Rise: The 14^th 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

• Nashville, TN

December 13, 2024 - Save the Date
MHR’s Client-Only Training

• Live Webinar

CALENDAR OF OBSERVANCES

Have you made plans to increase awareness of these observances?

July

          National Minority Mental Health Awareness Month

August

          National Immunization Awareness Month

September

          National Suicide Prevention Month

          Childhood Cancer Awareness Month

October

          Breast Cancer Awareness Month

November

          COPD Awareness Month

          American Diabetes Month

December

          New Year’s Eve-Quit Smoking Resolutions