A healthcare organization with a history of achieving single-product NCQA accreditations sought to expand into Case Management (CM) Accreditation and was willing to wait a year to work with MHR.

A mid-sized healthcare organization with a history of achieving single-product NCQA accreditations sought to expand into Case Management (CM) Accreditation. While they had internal resources and were developing a new software system tailored to CM requirements, they recognized the complexity of the NCQA standards and sought experienced external support to ensure a successful outcome.

Challenge

Brent, the Director of Quality and Innovation, had prior experience with Managed Healthcare Resources (MHR) and was impressed by the CEO’s detailed approach as an NCQA surveyor. He was eager to re-engage MHR for their CM accreditation. However, per NCQA contractual requirements, MHR was restricted from working with the organization until one year had passed since the CEO had served as a surveyor for their prior accreditation review. 

Rather than engage an alternative firm recommended by MHR, the client opted to wait until the one-year restriction lapsed, preferring MHR’s deep expertise and customized approach. 

Solution

Once eligible, MHR partnered with the organization to provide comprehensive accreditation consulting.

Services included:

• Gap Assessment: Conducted a thorough review of current operations against NCQA CM standards, identifying areas of strength and opportunity.
• Software System Evaluation: Advised on the alignment of the new CM platform with documentation and reporting requirements, helping to optimize system readiness.
• Staff Training: Delivered targeted training sessions to build internal capacity and ensure staff were prepared for documentation, process adherence, and survey readiness.
• Status Reporting: Developed real-time status reports organized by each standard, providing clear, actionable updates that guided the team’s efforts and maintained accountability.
• Strategic Coaching: Advised on prioritization, set milestones, and offered insights into common pitfalls—ensuring continuous momentum throughout the process.

Results

With MHR’s guidance, the organization achieved a Three-Year NCQA CM Accreditation, the highest term awarded by NCQA.

The Director emphasized:

“What really stood out was their attention to detail, the clarity of their real-time status reports organized by each standard, and their ability to personalize the experience to fit our specific needs.”

He further highlighted that MHR’s expert support:

• Kept the team focused and efficient
• Provided strategic insights that helped avoid delays
• Enabled the organization to exceed expectations across all required functions

Conclusion
This case exemplifies MHR’s ability to serve as more than a consultant—they are a strategic partner in NCQA success.

By blending deep standards knowledge with tailored support and operational clarity, MHR helps organizations not only achieve accreditation but also build long-term readiness and quality infrastructure.