Our Services
National Committee for Quality Assurance (NCQA) Accreditation & Recognition Programs
We are well-positioned (as a result of long-standing surveyor experience and chairing the Review Oversight and Reconsideration Committees) to assist clients such as MCOs, health systems, PHOs, and other entities in their review and preparation for NCQA accreditation/recognition that include: Health Plan Accreditation (HPA); Health Equities Accreditation (HEA); Managed Behavioral Health Organization (MBHO) Accreditation; Utilization Management, Credentialing, and Provider Network Accreditations; Complex Case Management (CM) Accreditation; Long-Term Services Supports (LTSS) Distinction; CMS SNP MOC development/submission; and QIS submission.
Quality Improvement Program Development
We can assess the status of clients’ current Quality Improvement programs to collaborate in the design and development of activities that will meet accreditation requirements while enhancing performance for optimizing results on Healthcare Effectiveness Data and Information Set (HEDIS) metrics and the Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys.
Creation of Impactful Population Health Programs
With successful past development and implementation of population health programs for Prenatal/Perinatal Care, Vaccinations, Asthma, Diabetes, Severe and Persistent Mental Illness (SPMI), and other chronic conditions, we are well positioned to partner with our clients in identifying and effectively addressing similar opportunities for improving the lives of their patients/members. Programs that address Social Determinants of Health (SDOH) and Health Inequities align closely with our passion to improve the lives of the underserved in our society.
Enhanced Care Management Services
We have designed and implemented effective care management programs serving other Medicaid Plans along with launching a robust care management agency (with NCQA accreditation) in support of regional Health Homes in NY State. We bring this expertise and experience in support of our clients wishing to do likewise for their respective organizations.
Successful Value-Based Payments Agreement Development and Implementation
We have successfully led efforts in achieving substantial payouts from “Value-Based Payments” arrangements as a healthcare delivery system (IPA) and also as a health insurer for governmental programs.
Health Plan Operations Development
Having been part of a team bringing a nascent Prepaid Health Services Plan for Medicaid into operation, we are familiar and comfortable in advising clients in the implementation and management of utilization management, quality management, credentialing, claims, member and provider services, behavioral health vendors and PBMs.
Utilization Management for Special Populations
Besides for a Medicaid managed care plan including the Children’s Health Insurance Program, we have implemented and received NCQA UM accreditation for UM programs in support of a Health and Recovery Plan for the Severely Mentally Ill, a Special Needs Plan for HIV/AIDS, and a voluntary FIDA Plan for the severely disabled. We offer these skills and insights to our clients.