Part 2 NCQA Accreditation Pitfalls Organizational Push back

Part 2 NCQA Accreditation Pitfalls Organizational Push back:

                Now in the quest to acquire the documentation that is required for accreditation you will invariably run into many groups internally that ask why do you need this and we don’t have time or desire to do this.   The best solution to this problem is you have a very high level sponsor for this undertaking.  You will need to pull out the “big guns” to get some of what you need done.  There will be times in order to get policies and procedures in place for 12 months at least you will need someone at the top level of your organization saying that this is not optional but mandatory and go do it.  You will fail in getting the accreditation done in the time frame you were looking to do without this support.  NCQA accreditation affects operations, legal, clinical and IT areas.  These groups typically don’t always work well together nor have solid cross-departmental working relationships.  You’ll need someone to lay down the law and usually a lowly manager or director isn’t going to have the pull.  Ideally the Chief Medical Officer or the COO is the ideal sponsor. They usually have enough clout cross organizationally to get movement.  Another situation that can arise is that you get asked to create the documentation for a particular group. This is a really bad idea for a couple of reasons. First is that you are writing documentation just to get accreditation. That’s not the purpose it’s to create an environment for better health care. It’s a situation to avoid at all costs.  The other issue that arises is now you are the owner of the documentation.  Should the NCQA team really own the SOP for training health coaches on Privacy issues???  This can be a real pitfall. This is where you need to pull out the big guns and get that particular group on board with doing what is needed. Another aspect to this situation is education. I cannot stress enough for the need for the accreditation organization to make its purpose, goals and needs understood by the company at large.  Many times companies do not spend the time and effort to understand what NCQA accreditation entails and what it means for a company organizationally. For some it’s something that is done every 3 years at the last minute and pass by the skin of their teeth or on probation. Many plans look at it as an extra burden that can be cast aside when times are rough. Very few realize that the accreditation put policies, procedures and process that are needed to survive in the very complex world of US Health Care.  Anyone operating in the compliance field understands the value of these and the protection they provide when state, federal or internal auditors arrive to do audit.   Ranging from sales to IT everyone has a vested interest in understand what accreditation entails and encompasses.