Co-authored by: Suzanne Kunze, Norita Wilson, and Lori Harris
For either NCQA or URAC accreditation, you’ll want to begin by preparing a readiness assessment. This assessment can take up to 18 months to complete and will prepare your organization for accreditation.
Phase I: Organize Assessment and Gap analysis
Whether a client is going through their initial accreditation or renewing one, you’ll want to begin by completing a readiness assessment and gap analysis.
The assessment helps define areas that need improvement and any validations needed to meet the requirements and criteria of an accreditation survey.
From this analysis, you will then want to create a roadmap in preparation of the accreditation survey. Everything should be analyzed, including quality improvement initiatives, staffing, marketing materials, satisfaction results, and policies and procedures.
Phase II: Restructured Service Delivery Model “Build Capacity” - Survey preparation
Health plans, Accountable Care Organizations, and Managed Care Organizations want to make sure they have everything available prior to submitting a survey.
A mock survey can be beneficial prior to completing the actual accreditation survey. By using a mock survey, organizations get useful information about their preparations. What things are missing? What information do they still need to complete the accreditation survey?
Phase III: Organizational Alignment - Integrated approach and electronic documentation
The assessment will also look at organizational alignment and identify any gaps. If there are gaps identified, the necessary corrections can be made. The health plan will also be able to gather all of the necessary documentation to submit for accreditation. This includes reviewing documents and preparing materials in advance of accreditation.
Phase IV: Transform Clinical Operations - “Accreditation and Population Health alignment”
The health plan will also want to transform their clinical operations, aligning accreditation to their population health goals. An accreditation in preparation for the assessment can identify and correct any issues prior to accreditation.
Co-authors: Suzanne, Norita, and Lori are associate directors with HighPoint's Population Health Management practice.