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NCQA
Overview
National Committee for Quality Assurance (NCQA) is an independent, 501(c)(3) non-profit organization whose mission is to improve health care quality everywhere.  NCQA accredits and certifies a wide range of health care organizations, recognizes physicians and physician groups in key clinical areas and manages the evolution of HEDIS®, the tool the nation's health plans use to measure and report on their performance.  NCQA evaluates health care in three different ways: through accreditation (a rigorous on-site review of key clinical and administrative processes); through the Health Plan Employer Data and Information Set (HEDIS® -- a tool used to measure performance in key areas like immunization and mammography screening rates); and through a comprehensive member satisfaction survey.  Although participation in NCQA accreditation and certification programs is voluntary, more than half the nation's HMOs currently participate, and almost 90 percent of all health plans measure their performance using HEDIS.
The Problem

Achieving NCQA accreditation is a goal for most managed care organizations that aspire after a standard of excellence, external independent validation, and promotion of quality in the markeplace.  However, maintaining a state of readiness and overall compliance can be an on-going challenge for many organizations due to the following NCQA requirements:

  • Documentation

  • Policy creation and maintenance

  • Education and Training

  • Cost

  • Administrative burden
The Solution

Windham Health has industry leading experts who can guide managed care organizations through virtually any quality improvement or NCQA accreditation-related challenge. Our consultants have vast experience in health care delivery and management, quality improvement and accreditation-related activities.

 

Our NCQA consulting services are based on a thorough understanding of NCQA's standards for managed care.  All of our consultants are highly skilled in interpreting the standards and offering proactive strategies to improve compliance.  They all have hands-on operational experience and extensive consulting expertise in both regional and national managed care organizations including: 

  • NCQA survey support
  • NCQA survey preparation
  • Designing and conducting NCQA education programs
  • Evaluating, developing and implementing quality improvement programs
  • Designing and conducting education programs on the principles, tools and techniques of quality improvement
  • Developing policies and procedures for NCQA compliance

 

Windham Health brings state of the art technology tools to guide all compliance projects.  The technological tools are customized to each client environment and then used to guide the design and implementation of solutions to achieve successful compliance reviews.  Our solution can be used over and over for future surveys as well.  We provide our clients with long-term strategies and real-world applications to meet their unique needs and improve their performance.

 

Windham typically begins every engagement with a rapid assessment of their readiness for survey. This is an interactive assessment process that provides extensive education for key staff, a thorough assessment of each standard, and a final report detailing the organization's compliance with each standard.  The assessment provides the foundation for an organization-wide action plan to become survey-ready.

Unlike many consulting organizations, Windham Health provides dedicated onsite resources that work in a collaborative, educational, and consultative environment while preparing for an NCQA survey. We assist client staff to understand the NCQA standards.  We identify high risk and poor compliance areas and then troubleshoot these areas to help our clients meet the standards.  Most importantly, we work with our clients staff to develop and implement action plans and solutions to prepare for accreditation.   Our solution is both repeatable and scalable and can be used to not only achieve compliance for a one-time survey, but to maintain the same level of compliance in day to day business operations.
...Our Experience is Your Reward
Our consultants all have extensive expertise and hands-on experience in their disciplines and have been onsite through many NCQA surveys with our clients.  Our automated tools provide the most effective and meaningful way to prepare for NCQA surveys.
 
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