At PSN, we provide expert NCQA accreditation preparation in the following areas:

• Health Plan (HP) Accreditation
• Managed Behavioral Healthcare Organization (MBHO) Accreditation
• Preferred Provider Organization (PPO) Accreditation
• Disease Management (DM) Accreditation/Certification
• New Health Plan (NHP) Accreditation
• Medicare Deeming (MA)
• Special Needs Plans (SNP)
• Credentials Verification Organization (CVO) Certification
• Physician Practice Connections (PPC)
• PPC-Patient Centered Medical Home (PCMH)
• Physician/Hospital Quality (PHQ)
• Utilization Management (UM) and Credentialing (CR)
• Privacy Certification for Business Associates
• Wellness and Health Promotion (WHP)
• Physician Recognition Programs in Back Pain (BPRP), Diabetes (DPRP) and Heart/Stroke (HSRP)

Our NCQA consulting services for these programs include:

• Assessment of documentation compliance to NCQA standards
• Expert blueprint for compliance
• Gap analysis
• Assembling of your application
• Policy and procedure development
• On-site mock surveys
• File audits
• Program design
• And more

When you work with PSN, you will be successful! To learn more, view our NCQA Accreditation page or contact us.

HEDIS measures are associated with many important health issues. Data collection includes collecting information about varied  aspects of care provided to individual health plan members by health plan participating physicians. Annually, information is collected through the review of randomly selected medical records located in physician offices or other health care settings to identify evidence of the following:

• Cervical Cancer Screening, Women Age 21-64: PAP test performed within 2010 or prior 2 years.
• Breast Cancer Screening, Women 40 – 69: Mammogram completed  in 2010 or 2009.
• Childhood Immunizations completed by 2nd birthday: immunizations administered include DTaP/DT, IPV, MMR, HIB, hepatitis B, hepatitis A, and VZV.
• Colorectal Cancer Screening, adults 50 – 75 years old:  Occult blood testing conducted annually or sigmoidoscopy in 5 years or colonoscopy in 10 years
• Comprehensive diabetes care, Age 18-75:  Yearly screening of HbA1c testing,  LDL-C, Retinal eye exam, nephropathy screening test,  Blood pressure measurement
• Controlling High Blood Pressure, ages 18-85: if diagnosis of hypertension is present, is blood pressure controlled, i.e. < 140/90.
• Prenatal and Postpartum Care, pregnant women: Prenatal visit occurred within first trimester; postpartum visit between 21 and 56 days after delivery
• Beta-blocker treatment after heart attack, Age 18 and older: for patients who were hospitalized and discharged after an acute myocardial infarction, medication prescribed included treatment  with beta-blockers for six months after discharge

Many health plans evaluate and utilize HEDIS data to enhance the quality of the health care services that they provide. HEDIS data allows employers, as well as benefit consultants, to select the best plans suited for their employees needs. NCQA makes sure that the HEDIS results are valid through a health plan audit process that checks the accuracy of  the HEDIS measures that are collected and also evaluates how the data is  measured.

HEDIS measures are essentially a report card that evaluates the health plan’s success in providing preventative care delivered by physicians in a health plan’s network of providers.

References:
Fallon Community Healthplan (2010) 2011 HEDIS® measures. Retrieved 1/22/2011 at
http://www.fchp.org/providers/resources/hedis-measures.aspx

National Committee for Quality Assurance  (2011) 2009 HEDIS Performance Measures. Retrieved 1/22/2011 at
http://www.ncqa.org/tabid/855/Default.aspx

1. Provide adequate resources: The NCQA standards not only address quality improvement, but they also address a number of other areas, too. Areas such as utilization management, provider relations, marketing, informatics, member services and support must be involved. These areas must be supported by senior management and must be given the training and time to devote to the survey preparation effort.
2. You can never start too early: Many NCQA standards require an organization to demonstrate compliance over a number of years. It is advisable for an organization to start preparation activities three years prior to a survey. This will afford the organization with time to make sure that structure and processes are in place and that required measurements and improvements can be documented.
3. Engage expert help: Preparation for an NCQA survey requires expertise in NCQA subject matter and complex project management skills. Often times the day-to-day working operations within an organization are all encompassing and do not afford individuals with the time to devote to the NCQA process. If permanent staff devoted to NCQA oversight and preparation is not possible, consider investing in a NCQA consultant. A NCQA consultant can establish project plans, interpret the intent of the standards, assess compliance, participate in and coordinate preparation activities, and track time lines and milestones. If considering the use of a NCQA consultant, make sure that the consultant is an NCQA surveyor. Only an NCQA surveyor will truly understand the NCQA process, the intent of the standards, the philosophy behind NCQA accreditation and certification.

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Written by: Ellen Pauley, RN, MSB. Ellen, one of PSN’s NCQA consultants, has been an active NCQA surveyor since 1991 and helped to develop many of the NCQA Accreditation and Certification products.

PSN is an industry-leader in NCQA accreditation services.  Each of PSN’s NCQA consultants have worked as NCQA surveyors, have over 30 years of combined NCQA surveyor experience, and total more than 50 years of NCQA consulting experience.  Feel free to contact us to learn more about our NCQA accreditation services.