How long does it take to become accredited when we have no previous accreditation?
It takes at least 12 months to attain the initial accreditation, much longer than any executives want to hear.
They believe NCQA is like other accreditors; you can be ready in a few months. Although almost everyone thinks they are already NCQA-compliant, the “devil is in the details,” we always say. To be scored at 100%, you must meet the data sources, the look-back periods, and the details of every single factor in the stem, Factor, and Explanation. Not meeting the look-back period requirement for every factor will place your score at 0%, which organizations are unfamiliar with. This is why NCQA is much more rigorous than any other accreditor and takes much longer than anticipated.
If we have people with accreditation experience in accreditation leadership roles, can that fast-track us into becoming accredited earlier?
Maybe, and maybe not. Usually, the answer is no.
NCQA accreditation takes a village to complete the documentation, even for the lower bar of Interim Health Plan Accreditation, when the ink can be wet, and member materials must be approved but not necessarily sent out. Your MHR consultant can assist you to prepare materials faster, but we have found that usually the delay is on the organization’s side to obtain approval for suggested modification to documents that would make them compliant.
We have never used a consultant. We hear the old joke (which is not funny) that when you ask a consultant the time of day, they borrow your watch and tell you the time. We don’t want to waste our money. How do we know you won’t do that?
You can ask our very satisfied clients who offer to provide references for us.
The MHR consultants live in the real world and not the theoretical world. All have been involved in quality improvement for many years and were responsible for some or all parts of the accreditation process, some in several states because experience matters. We live in the weeds, which is where you live. We usually have worked in more than one health plan and all but trainees have worked with clients across the US with different models and lines of business. Those that are surveyors have even more experience.
Therefore, we have considerable experience and have most likely been exposed to more situations than surveyors or consultants individually and certainly more in combination. We have walked in your shoes and know what that feels like. We strive to be prudent stewards of finite health care dollars and do not recommend anything that does not provide value to your organization, whether they are projects, documents for purchase or trainings.
We have delegates that need help understanding NCQA and what is required. Can you help us?
Certainly! Almost half of MHR’s clients are pursuing delegated product accreditation, such as physician or hospital organizations seeking Utilization Management Accreditation (UMA) or Credentialing (CR) or Credentialing Verification Organizations (CVOs) for certification, Managed Behavioral Health Organizations (MBHOs), Case management (CM), Population Health Programs (PHP), Wellness and Health Promotion (WHP), Health Information Products (HIP), Health Equity (HE) and HE Plus, and Case Management-Long Term Services and Supports (CM-LTSS).
Therefore, we have a 360-degree view of health plans with all types of delegates and can provide the perspective of both sides. The MHR consultants have dealt with all these organizations with their initial accreditations and know “what they don’t know” when they begin so we can provide that perspective to the delegating organizations and the perspective of health plans to the delegates. This is unique in consulting firms and extremely rare in boutique firms like MHR.
Why should I use a consultant or even MHR?
You want to be successful the first time, and MHR consultants reduce uncertainty about passing a survey and what the intent of the standard is.
Almost all our clients receive 98 – 100% for their surveys, even Renewal Surveys, where the requirements are much more stringent. We prepare you for the surveyor who will hold you to the requirements of the standards, including the bulleted areas of the Explanation when the standard states these must be included. We are known for our detail. You will never be surprised at whatever the surveyor appropriately identifies as a gap because we have prepared you for a gap you did not fix before the survey – if we had a chance to review the documents.
Why wouldn’t we get 100% if we use you?
We’d love to guarantee you will receive a 100% score if you use MHR, but many variables are out of our control.
1. If you have already applied for a survey before you start working with us, and the look-back period has begun or is about to occur before we can identify gaps, there is inadequate time to fix them. The documents must comply at the beginning of the look-back period to receive all points.
2. If you do not provide the document for our review and think it is compliant. The surveyor finds it is not, there is nothing we can do to fix that.
3. Even if you have time to fix an issue, the accreditation team must depend on other areas to mitigate gaps, and if the gaps are not modified in a timely manner; it is what it is, and there is nothing we can do except help you place it in the best light for the surveyors when identified.
Do you have specific requirements for working with you, like requiring a review of all documents for a gap analysis or starting at a specific time before the survey?
No. We are flexible in our approach to clients.
If you do not want a recommended service, such as a full gap review, we will tell you the risk involved across all standards. However, it is your budget, your organization’s accreditation result, and your risk, not ours. We highly recommend that you obtain a full gap when we start working with you, but some have limited budgets and do not wish to have that done.
One note: If we have not reviewed documents because you did not send or did not send two years’ worth of analyses, we will score you and allocate risk accordingly. That means you will score a 0% on our proprietary gap assessment tool when we do not evaluate a document or score you only as high as 50% for one compliant analysis instead of two.
These standards/elements/factors will be flagged as a moderate to high risk on the risk score. That is our policy and your risk as a worst-case scenario. Because we follow NCQA’s scoring methodology. We can only score according to what we see and have seen. We’d love to take your word for it, but NCQA does not, and neither do we. Our founder says “In God we trust; all others must provide documentation”!
We have a limited budget. Can you still provide services?
Yes, we can, but please realize we do not have magic wands.
Clients who use us on a limited basis have been known to get Corrective Action Plans (CAPs) for standard documents they do not send us. We will assist you in using the budget to prioritize high-value standards, such as must-pass file reviews for UM (denials and appeals), credentialing and recredentialing files, and System Controls, along with high point value files (complex case management) and analyses.
Because we are known for the level of detail that the most rigorous surveyor will hold you to, just because there has never been an issue in previous surveys does not guarantee that you will pass it on a subsequent survey. Besides variability in review, NCQA changes interpretations in the tri-annual publishing of policy changes and clarifications and subsequent standards years. Prudent clients will ask for MHR’s review of existing documented processes and materials to confirm compliance.
We don’t know what we don’t know. How do you work with us, so we become successful?
You’re the best client for us!
We love to teach and train subject matter experts on the intent of the standards’ requirements and help you apply them to your organization. You are the expert on your organization’s culture, people, and processes and can see how they would fit. We teach you to fish and do not fish for you. If you have doubts, you can talk to our clients. Fishing for you can help you become accredited in the short run, but it is not a long-term solution. That is because there are finite dollars to spend on accreditation, and having it done for you is costly.
Additionally, organizations are always moving and changing. If you do not learn how to maintain accreditation instead of always having toattain accreditation your organization will always be in crisis mode. We also have a recommended system for clients to sustain accreditation.
We are so new to accreditation that we don’t have the tools to write documentation. Will you do that for us, or do you have templates?
Yes, we can help clients who do not have resources or pre-existing tools to develop compliant documentation. (See values about fishing for you vs. teaching you how to fish.)
We have tools developed using a robust development and review process by several consultants that provides the highest quality of tools for you to use to develop the documentation for you as necessary.
Our staff is not knowledgeable because we’re new to accreditation (or there has been massive turnover). How do you approach this?
We have training presentations for all the health plan standard sets and every product NCQA accredits.
We also have many more targeted topics of interest, such as System Controls, Delegation, Analysis, and others. We do not provide a listing of templates and tools nor presentations to those who are not current clients due to the competitive advantages of this intellectual property. Non-clients cannot purchase these tools as they are used in the context of the consulting process.
These tools and trainings are not magic bullets. No tool can fix issues like placing inaccurate or incomplete data in the analytical tools or not following the instructions for how to conduct a compliant qualitative analysis. Training presentations provided to business owners without their incorporation of the content will not fix lack of knowledge.
We just want to meet the minimal requirements and check the box that it is done. Are you OK with that?
No, we’re not. We will not take on box checkers if identified during the Discovery process. Money in health care is too precious to be wasted on checking a box.
We are invested in doing meaningful work with clients instead of backfilling data in analyses and hoping it will work with the surveyor. Those of us who are seasoned surveyors can identify that strategy very easily. Hope is not a constructive strategy.
We will add LTSS Distinction to our Health Plan Accreditation for the Medicaid line of business as our state requires it. Can you help us with that?
We have worked successfully with other clients to obtain LTSS Distinction and have two Subject Matter Experts (SMEs) on our team, both of whom are NCQA surveyors and have surveyed this distinction.
Health Equity appears to be important with regulators, and we’re always being asked about that accreditation. Our leadership wants that accreditation in five months. Is that doable?
Sorry. Not in your wildest dreams. This data-dense accreditation follows a few of Murphy’s Laws: Nothing is as easy as it looks.
Everything takes longer than you think. Many data points are not routinely captured by most organizations, and a few Elements require data segmentation, quantitative and qualitative analysis, and acting on opportunities (HE 4) – even for initial surveys. This all takes time. Most organizations need at least 12 and occasionally 18 months when working thoughtfully and meaningfully on this accreditation.
What is your approach to working with organizations?
If you are a health plan, we assign a team leader who works with the accreditation staff on strategy and high-level areas. She also monitors work (emails and document review) to maintain timeliness of response among team members.
Two others are assigned to the team: one non-clinician for the non-clinical standards and a clinician to manage the clinical standards. Clients have voiced a high level of satisfaction with this model.
All team members are copied on emails so there is a comprehensive view of the accreditation process. Those not assigned to the standard keep it for reference in case a team member is absent for a survey, vacation, or other reasons for time away from work, so there is always someone who can step in to answer a question.
Are there other reasons to use MHR for NCQA accreditation consulting?
Several years ago, a client using MHR who had finished three successful NCQA surveys (after a previously poor outcome using another firm) and one URAC survey was asked this question. He said, “You’d be foolish not to use MHR!”
The founder thinks of this often in contemplating why potential clients should use our services. We hold to a high internal standard of work excellence, high ethical practices and live our mission and vision. We use the Golden Rule in working with clients. How would we want to be working with us and what would greatly satisfy us if we were on the opposite side of the table obtaining accreditation?
We want to be easy to work with and provide great value to our clients and always keeping the client’s perspective in view. Besides viewing us as trusted advisors, most of our clients become our friends. As your partner, your success is our success, and we take your trust in our capabilities very seriously. That is not just a platitude; it’s how we roll.
If you’re not our client, why wouldn’t you want to be?