Case Study #4: Complex Situation with Delegation of Most Activities to External Organization.
A health plan with almost 100% delegation to other entities, retained MHR for their First Survey.
A health plan with almost 100% delegation to other entities, retained MHR for their First Survey. A different consultant was used for the Interim Survey. The contracting process took almost five months and was finally executed eight months prior to their survey. After the kickoff transition meeting between the MHR President and Lead Consultant/Project Manager (PM) and the accreditation lead for the Plan, there was basically radio silence. The PM used multiple methods to attempt to engage the accreditation lead, with only a few discussions and no documents sent for consultant evaluation for over five months. Four months prior to their survey, MHR was notified that this person left the organization, and a new contact was identified. As with other clients in crisis, MHR used many consultants to assist the organization in writing analyses and teasing out the delegation oversight responsibilities and documenting needed oversight of the health plan’s responsibilities and providing recommendations for amendments to the delegation agreement to provide specificity.
MHR consultants did all document preparation and submission of the survey, along with file preparation for the files identified by NCQA for review. The organization received an almost 100% score. After the survey, the organization purchased the MHR suite of Delegation Oversight Tools to assist them in be compliant on a go-forward basis. MHR continues to work with the organization, holding monthly to bi-monthly meetings with leadership to assure ongoing compliance for gap identification and mitigation, along with strategic planning for the Renewal Survey.
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