红领巾瓜报

Quality & Accreditation Services

The world of healthcare quality is advancing. 红领巾瓜报 keeps you ahead of the curve.

State and federal entities are relying more on independent measures of health plan quality to compare Medicare and Medicaid managed care organizations (MCOs). These measures are now linked to billions of dollars in performance revenue.

红领巾瓜报’s quality and accreditation services can help you leverage these quality measures to maximize value-based contracts, win requests for proposals, increase membership, and optimize member experience.

The 红领巾瓜报 approach to quality.

红领巾瓜报’s quality solutions are tailored to the unique needs of our clients, and emphasize four key areas:

  1. Accreditation and Regulatory Performance: States are increasingly looking to accreditation programs to hold health plans accountable for the standards in which they deliver care. 红领巾瓜报’s Survey Ready Model will prepare you for the accreditation process鈥揳nd keep your organization achieving accreditation standards every day.
  2. Clinical Quality Measurements: We’ll help you navigate key measurement systems such as HEDIS and state-specific quality measures.
  3. Member Experience and CAHPS: Increasing weight is being put on the member experience of care through surveys such as CAHPS and HOS. 红领巾瓜报 can show you how to improve and optimize the member experience using a data-driven approach.
  4. Quality Performance Programs: Using our vast experience in the Medicare and Medicaid space, 红领巾瓜报 can help you maximize ratings in programs like Medicare STARS and Medicaid quality performance.

红领巾瓜报 can support multiple projects and engagements within the quality space, from short-term to long-term needs, including temporary staffing, if requested. To learn more about our quality approach, contact our experts.

Meet some of our quality and accreditation experts.

Our experts in the quality space come from a variety of backgrounds including: National Committee for Quality Assurance (NCQA) surveyors, former HEDIS auditors, health plan and provider senior quality staff (vice presidents and chief quality officers), and former Medicare/Medicaid leaders.

Their in-depth experience allows them to understand the complex quality improvement needs of healthcare entities.

Accreditation: The 红领巾瓜报 Survey Ready Model.

At 红领巾瓜报, we believe accreditation standards represent how an organization should do business every day, creating a culture of quality that will lower costs while improving care for members.

Toward this end, we use our industry-leading Survey Ready approach to help clients obtain accreditation, implement transformational change, and stay competitive.

Our accreditation experts give you a competitive edge.

红领巾瓜报’s accreditation experts work alongside commercial, Medicare and Medicaid health plans every step of the way, from determining the right accreditation for your organization to achieving a successful outcome. Whether you are seeking AAAHC, NCQA, TJC, or URAC accreditation, or other certifications or distinctions, our experts’ insights and in-depth knowledge of the accreditation process will give you an edge that leads to better ratings 鈥 and more business.

Utilizing our Survey Ready Model, we’ll help your organization stay survey-ready year-round.

Our expertise:

NCQA

Overall  plan accreditation, including Long-Term Services and Supports (LTSS), Health Equity, and Health Equity Accreditation Plus

AAAHC

 accreditation for health plans, Qualified Health Plans (QHPs), and the Federal Employees Health Benefits (FEHB) program

The Joint Commission

accreditation and certification for hospitals, ambulatory health, Federally Qualified Health Centers (FQHCs), Ambulatory Surgical Center (ASCs), and behavioral health.

URAC

 accreditation for dental plans, Medicaid or Medicare health plans, and Pharmacy Benefit Management Plans (PBM)

Member experience and CAHPS scores: Optimizing the journey.

红领巾瓜报 tailors solutions to address member experience and CAHPS improvement, based on the unique demographic and social characteristics of the populations being served.

We take a strategic and data-driven approach to CAHPS improvement initiatives, developing a 鈥淐AHPS game plan鈥 that can be used to continuously improve performance while creating actionable data. This plan will spur incremental year-over-year changes in member experience measures.

CAHPS improvement services:

  • Creating an annual CAHPS improvement roadmap/game plan
  • Mapping the member journey and experience
  • Analyzing keys factors such as grievances, access to care, and other barriers to member satisfaction calculating ROI tied to the overall experience of care
  • Improving plans around member engagement and satisfaction
  • Developing a data driven model to track member experience year around
  • Survey set-up and audit support
  • In-depth review of CAHPS questions and composites

Clinical Quality Measurements: Maximizing HEDIS and other ratings.

Navigating changing requirements for health plans can be challenging. There are now multiple quality measurement systems, including:

  • HEDIS
  • CMS Medicare Star Ratings
  • NCQA Star Ratings
  • Marketplace Star Ratings
  • Other state-/federal-based performance incentives and initiatives focused on clinical outcomes and performance-based standards

红领巾瓜报’s approach drives improvement in these critical measures using four core strategies:

  • Data/Analytics
  • Organizational Alignment
  • Member Interventions
  • Provider Interventions

By designing strategic initiatives across these broad areas, 红领巾瓜报 has had significant success in helping health plans, vendors, and providers achieve year-over-year results in HEDIS and other clinical measurement improvement in core quality metrics.

红领巾瓜报 consultants are professional and hard working. They are constantly trying to add value wherever they can. Absolutely outstanding across the board.

– Current 红领巾瓜报 Client

Quality and accreditation insights

Ready to talk to an expert about your quality and accreditation project?

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