NCQA Health Plan Accreditation

You my friend are a savvy Healthcare Executive.  You may be an experienced Compliance Officer, or a leading Director of Quality Management.  You might work for one of the largest well known Health Plans in the nation.  Perhaps one that takes care of the healthcare needs of millions of individuals, and you may have been through NCQA Health Plan Accreditation before.  Yet this time around, your organization is struggling.  That interim NCQA Health Plan Accreditation which was difficult, but not insurmountable to obtain has transitioned into a much more complex, dynamic  and frightful beast as you find yourself up for NCQA re-accreditation, or the move to full accreditation status.

• If your accreditation is severely behind schedule, you need to read this.

• If you are finding that different parts of the organization are at completely different levels of readiness you need to read this.

• If this accreditation has cost you in manpower, time away from the daily work of doing business, and sheer HR resource cost much more than you ever imagined, you definitely need to hear recommendation number three!

• Finally, if you know the date for your accreditation readiness survey, and have no idea how your team is going to be fully prepared on time, it is time to stop spinning your wheels, rethink your strategy toward accreditation readiness, and put in place a new plan today.

Let Us Show You How….

and Don’t Worry, It is Not Too Late and You Are Not Alone! 

Let’s take a look at the four reasons why you are currently failing, and more importantly, discuss the THREE ACTIONABLE STEPS YOU CAN TAKE TO TURN THINGS AROUND, but before we do, let us just fill you in on one piece of information that may bring you a bit of solace.  You are not alone. In fact only about half of the nationally recognized health plans have achieved.  According to a recent article by Managed Care’s Contributing Editor Bob Carleson  “In general, health plan performance has improved tremendously since 1991, when the NCQA began accrediting health plans, and that improvement raises the bar for current candidates. If Plan A successfully undergoes the inspection, which NCQA calls an “on-site survey,” without breaking a sweat, it’s natural to wonder why the people at Plan B are having such a bad time of it, especially since they’ve been through the process before.”  But people are having a hard time of it, and here are the top four reasons why

1. Lack of Leadership

Organizations who do not have a strong internal advocate with the power and ability to allocate necessary resources are the first to fail.  The organization may find that day to day operations run like clockwork, but when it comes to accreditation, and showing how the health plan meets these standards, executive teams may not have rallied behind the accreditation efforts.

• Executive Members Need to Fully Support Accreditation Efforts
• Successful Health Plans have an internal leader who takes ownership of the Accreditation process and communicates to all departments
• Leadership buy in means appropriate funding for Accreditation Initiatives (Especially Project Planning, Support Resources, Training, etc.)
• Effective Leadership allows all parts of the organization to own their portion of accreditation, ensures needed resources to complete accreditation readiness, and encourages “buy in” of accreditation as not just a one time or every three year challenge, but a daily way of conducting business!

Recommendation: If your Health Plan Lacks An Accreditation Champion, put one in place immediately, someone with leadership abilities who can positively impact staff, and is high up enough in the organization to allow for resource allocation.  Allow this person to assemble an Accreditation Committee bringing together all key departments across the organization so that everyone has skin in the accreditation game and owns the standards which are most applicable to their department.

2. What Do You Mean You Don’t Have a Timeline?

Accreditation, especially accreditation as complex as NCQA Health Plan Accreditation needs a timeline…..and if the only thing on your timeline is your survey date….you are in trouble.  Having a solid timeline with deliverables, expectations, plans, milestones, and responsibilities is priority one for ALL ORGANIZATIONS WHO WANT TO BECOME SUCCESSFULLY ACCREDITED. If your organization has not completed a timeline for your health plan accreditation stop right now.  Don’t go any further.  Put down those half drafted policies and procedures, tell your IT department to hold up on pulling the reports.  Sit down and put your timeline in place right now, before you pass go, before you collect a negative accreditation rating.

THE NUMBER ONE REASONS HEALTHCARE ORGANIZATIONS STRUGGLE IS BECAUSE THEY DO NOT NAIL THE TIMELINE. 

So, now that we know that timing is everything, what are key timeline parameters that your organization should be aware of?

• Allow yourself, on average, 3 years of preparation for first time NCQA Health Plan Accreditation
• Re-accreditation preparation should begin the second your first onsite survey has concluded…..NCQA Health Plan Accreditation is a commitment to ongoing or continuous readiness, so you cannot take time off from accreditation
• New NCQA Standards are published July 1st of each year.  Mark this on your calendar (and on your timeline) so that you can stay up to date regarding changes between accreditation
• Make sure that you schedule mock audits in time to adjust and correct any deficiencies to your organization (mini mock audits can take place on an annual basis, comprehensive ones should take place 45-60 days prior to your actual onsite survey date)

3. Know When to Call For Help….and What to Look For When You Get It

Ok, perhaps you did not have a corporate leader at the beginning of your NCQA Health Plan Accreditation journey.  Perhaps you didn’t have a solid timeline in place, and you now find yourself a bit behind.  Perhaps no one had ownership of keeping up with things in between accreditation cycles and you now realize that your next onsite survey is less than 12 months away, no one has kept up with meeting minutes in the past 18 months, and the last time you looked at the standards was during your initial accreditation.  This of course is a worse case scenario, but these are common things that happen to organizations.  One thing that we cannot emphasize enough is that not only is it ok to get external help during the accreditation process, but those organizations who get assistance in a proactive manner can save time and money on accreditation preparation. 

Here are our recommendations for getting expert NCQA Health Plan Accreditation Assistance

• Engage with an expert at the beginning of the accreditation or re-accreditation process.  Let this person project manage your accreditation and save everyone involved stress and internal friction trying to stay on top of a rapidly approaching deadline while doing daily work
• There is no substitute for experience.  Even if you do not hire an expert or NCQA Health Plan Accreditation Consultant to guide you through accreditation from start to finish, at the very least retain an expert who has been through the accreditation process before to serve as a resource for your staff.
• When looking toward external experts, make sure that they meet the following requirements:
  • Has worked in healthcare, preferable as a surveyor for the accrediting body (in this case NCQA)
  • Has successfully guided other organizations toward this accreditation type
  • If project planning is involved, ensure that this person is certified in project management and has the technology at their disposal to meet the needs of a large Health Plan (an excel project plan will simply not cut it)
  • Does this resource have tools/templates/materials to assist your health plan in prepping for accreditation? They should.  They should be tried, tested, and accreditation approved
  • Does this organization have a 100% success rate for accreditation assistance projects?