MHR Newsletter
2024 #1
January 23, 2024
By: Nancy Ross Bell
From Susan
In case we haven’t spoken yet, I wish you a happy, healthy, and prosperous new year! It’s that time of year when we look ahead and set in motion our plans. Like your organization, I, too, set goals for MHR. To help our team in planning for the year, I considered various factors, such as:
- What is NCQA’s direction on programs and standards?
- What predicted healthcare industry trends could impact an organization’s NCQA survey preparation?
- How can MHR better serve our clients to help you improve healthcare quality through NCQA accreditation?
- What are the needs of MHR’s consultants to maintain their expertise?
If you haven’t already done so, shop NCQA’s Store for new releases of NCQA’s 2024 standards, including Health Plan, Health Equity, CVO, Case Management-LTSS, and UM/CR/Provider Network. You must always use updated standards for your survey. (Also, be aware of NCQA’s Publication License Agreement when shopping for standards.)
What are some of the predicted industry trends? Look below under NEWS, where several articles describe these that, if applicable to your organization, could warrant updates to your quality program structure, vendor and delegated arrangements, and population health programs. The continuance of mergers and acquisitions and consolidations, talent shortages, new value-based care models, more telehealth and wearable devices, patient-centered care goals, an increase in dual-eligible members, and a shift to more self-insured members from fully insured are just some.
Available for you now is a new consulting and training program on Staffing Assessment. This new program, developed with insights from Kimberly Carpenter Petit, is targeted at the role of leadership in assuring resources are available across an enterprise to attain and sustain NCQA Accreditation. This unique program helps organizations understand the effort needed and the value obtained from NCQA Accreditation. Let us know if you are interested.
Then, Save the Dates for our upcoming Client-Only Training sessions, where our consultants provide recent updates to NCQA standards they have learned from Surveyor training, plus affords you time to ask questions. Mark your calendar for these dates:
- April 12, 2024
- August 9, 2024
- December 13, 2024
Lastly, MHR’s team of consultants is one of the top in preparing organizations for NCQA Accreditation. Results show it. Our consultants, most of whom are also NCQA Surveyors, attend NCQA training, keep updated on changes to standards, share insights from NCQA on policy questions, and rally together when our valued clients need “intense” support in a short timeframe! We know you depend on us, so maintaining a high level of expertise is always our goal!
As you turn the page, read about MHR’s Consultant, Sheila Petras, who many of you may already know!
As always, let me know how we can help.
Susan K. Moore, President & CEO
GET TO KNOW MORE ABOUT
SHEILA PETRAS, MSHA, BSN, RN, CPHQ
MHR Consultant
Moving into consulting on NCQA Accreditation was a natural path for Sheila, who already has over 25 years of experience with quality and NCQA accreditation. With over ten years as an NCQA surveyor, Sheila consults primarily on NCQA Accreditation for Health Plan (HP) and Utilization Management/Credentialing (UM/CR).
As one of MHR’s clinical consultants, Sheila is passionate about quality and spends many hours working with clients in preparation for file reviews and working with their subject matter experts (SMEs) to uncover processes that are in place to meet the intent of the standards. If existing processes don’t fulfill the intent, Sheila will assist the SMEs in identifying their gaps and brainstorming with the team to enhance or revise the current process to meet the requirements.
Sheila knows NCQA Accreditation can be challenging for organizations, particularly those that are new or perhaps smaller with limited staffing resources. Her approach is to train and coach the accreditation team and SMEs and interface with executives as needed.
As an MHR Consultant, Sheila is flexible as she works across time zones. She is prepared for those times of year when organizations are about to submit their survey, and emotions tend to run high. She is comfortable escalating issues when needed and using those interpersonal skills with executives to meet the organization’s needs. Sheila motivates organizations to do the “right thing,” which adds value and ultimately helps them achieve NCQA Accreditation.
Sheila has seen significant changes in NCQA Accreditation over the years, moving from paper submissions to electronic submissions along with NCQA adding more clarity on the standard’s intent, scope of review, and explanation while introducing new standards on systems control, telehealth, and delegation.
Sheila has the best of both worlds! While consulting part-time with MHR primarily on the clinical aspects of the standards, she has time to refresh herself with a relaxing round of golf and a walk on the beach. Spending time with friends and family, including six grandchildren aged 22 to 10, makes each day a new adventure.
You can learn more about Sheila on the MHR website under About Us.
QUALITY INSIGHTS
- Don’t stop now!
Remember that NCQA’s recently proposed changes are just that – proposed! Follow the current year’s standards by which your organization will be surveyed and not the proposed ones. NCQA’s 2025 standards are effective for surveys on or after July 1, 2025.
- Keep updated with MHR’s Blogs and Newsletters!
MHR’s Blogs and Newsletters are written with YOU in mind – the people doing the work for an upcoming NCQA survey and keeping quality continually in sight once your survey scores are in! Be sure to distribute them to your quality teams as they provide unique insights from our Consultants.
NEWS
What to Expect in US Healthcare in 2024 and Beyond
2024 Outlook for Health Care Planning for the Future of Health: Top Trends for 2024
“Medicare Advantage Plans are Crippling Rural Hospitals”, CEO says.
States are Adopting New Policies to Help Children Stay Enrolled in Medicaid and CHIP
Children Care Gaps in Rural American Threaten to Undercut Small Communities
Disability Inclusion as a Cornerstone for Health Equity
CCHP’s End-of-Year Review: Right Back Where We Started
Roundup of 2023 Approved State Telehealth Legislation
3 Stats on Prior Authorization Effect on Cancer Care
Prior Authorization Promotes Evidence-Based Care That Is Safe and Affordable for Patients
UPCOMING INDUSTRY EVENTS
February 22, 2024
NCQA’s Live Webinar on Race, Ethnicity, SOGI, Income, and Language in Patient Reg
- Webinar
February 27-29, 2024
AHIP Executive Leadership Summit
- Phoenix, AZ
March 4-5, 2024
NCQA Health Equity Forum
- Los Angeles, CA
March 12-14, 2024
2024 Medicare, Medicaid, Duals, & Commercial Market Forum
AHIP
- Baltimore, MD
April 2-3, 2024
RISE The Medicaid Managed Care Leadership Summit
- Virtual
April 12, 2024
MHR’s Client-Only Training – Save the Date
- Live Webinar
April 19-22, 2024
2024 National Conference American Case Management Association
- Nashville, TN
May 1-3, 2024
RISE The Special Needs Plan Leadership Summit
- New York
May 29-30, 2024
CMS Health Equity Conference
- Bethesda, MD/Virtual
- Las Vegas, NV
August 9, 2024
MHR’s Client-Only Training – Save the Date
- Live Webinar
September 9-11, 2024 – Save the Date
NAHQ Next 2024
- Virtual
October 31-November 2, 2024 - Save the Date
NCQA Health Innovation Summit
- Nashville, TN
December 13, 2024
MHR’s Client-Only Training – Save the Date
- Live Webinar
CALENDAR OF OBSERVANCES
February
National Wear Red Day (2/4/2024)
National Children’s Dental Health Month
Teen Dating Violence Awareness Month
National Black HIV/AIDS Awareness Day (2/7)
March
American Diabetes Alert Day – March 26, 2024
April
National Infant Immunization Week (April 21-27)
Administrative Professionals Day (April 24, 2024)
May
MHR was incorporated in 1991 and specializes in preparing organizations for all NCQA accreditation and certification products.
All MHR consultants were responsible for NCQA accreditation in their previous roles before joining MHR as an independent consultant. Most consultants are also NCQA surveyors and the majority are clinicians.
We welcome hearing from you!
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