Great Idea from NCQA!!

It's good to see NCQA engaging its members in a interactive way!

Announcing: NCQA's New Accreditation Users Group

The National Committee for Quality Assurance (NCQA) is excited to announce the Accreditation Users Group (AUG). The AUG provides a new communication, learning and development platform for members to discuss updates to existing NCQA Accreditation and Certification products, and how they are applied. AUG members will also have the opportunity to contribute to the enhancement of future products. The AUG will cover the following accreditation and certification products:

• Health Plan (HP) Accreditation
• Disease Management (DM) Accreditation
• Managed Behavioral Healthcare Organization (MBHO) Accreditation
• Wellness and Health Promotion (WHP) Accreditation
• Accountable Care Organizations (ACO) Accreditation
• Case Management (CM) Accreditation
• Disease Management (DM) Certification
• Health Information Products (HIP) Certification
• Physician and Hospital Quality (PHQ) Certification
• Credentials Verification Organization (CVO) Certification
• Utilization Management/Credentialing (UM/CR) Certification
• Medicare Advantage (MA) Deeming
• Multicultural Health Care (MHC) Distinction

AUG members also receive the following benefits during the subscription year:

• A $200 voucher toward an NCQA Accreditation, Certification or HEDIS publication, or toward a license for the Interactive Survey System Survey Tool.
• A $200 voucher toward any NCQA educational seminar.
• A $100 voucher toward NCQA's Quality Compass.
• NCQA WebEx sessions that address key updates and user-expressed topics of interest.
• Access to the Users Group Member Download Center, which include recorded training sessions, presentations and other valuable user-only materials.
• Access to the monthly Users Group newsletter, which lets subscribers know about recent policies and issues that have the potential to affect their organization, and includes information about Webinar trainings, policy updates and publication release dates.

The AUG membership fee is $950 per year, which follows NCQA's standards year (July 1 to June 30).

If you are seeking NCQA Accreditation or Certification for any of the products listed above; provide guidance to organizations covered under the scope of the products; or purchase services from an NCQA-Accredited or NCQA-Certified organization, we invite you to consider joining the AUG.

To sign up for the Accreditation Users Group, click here. If you have any questions about the AUG, please contact Veronica Locke at locke@ncqa.org.

Compliance warning sign

There always comes a time when a compliance professional needs to give his organization a reality dose. When your organization decides the compliance team needs to maintain documentation that's owned by another group because they don't have the time to keep up with it that's a major problem. The compliance team is job is to make sure that all departments keep their documents up to date and reviewed at least annually. Once you take on the role of setting up the reviews and assign work you open yourself to doing this for all departments.  This will become time consuming and drag your group's resources away from their main goal of compliance. There are a lot of fine document management systems out their. Have you company invest in one.

Compliance - Clinical

When it comes to clinical compliance I'm going to look at it from the policy and procedure  point of view.  As a compliance professional you do not have to be clinical to make sure it gets done.  You have to make sure your clinical group gets it done.  Your clinical group really has the ownership of the materials and policies.  They need to recognize the fact these need to get reviewed and updated at least on a yearly basis. As a compliance officer your job is make sure they do theirs.  Nobody really wants to get hounded to do things but sometimes you do need to explain why it is important to do things in a timely manner. Like the Aviation field health care is going to get the same level of scrutiny as that field does. Once you accept that fact as an organization you will be much better prepared.                                                                                                                         What does need to get reviewed on at least an annual basis? Anything clinical that can change on at least a yearly basis. Sounds pretty broad doesn't it? Well it is, and the reason it is you should never assume anything. For example let say you do health coaching for diabetes as a company.  You'll need to review what you coach on. That means you'll need to review changes in diabetes care, changes in diabetes medication, changes in diabetes health, fitness programs for diabetes, etc, etc. This might be a pain but  as a health organization you have to do this.  URAC and NCQA expect this, so do the feds and the state folks also. Besides isn't it best practice to review these items anyways?
Compliance isn't about making people miserable internally, compliance should really be about making people externally healthier by making sure you provide the best care possible.

What is compliance? Internal Oversight

I ended my last post about internal oversight so I'm going continue with that. Who owns compliance? The reality is that it is everyone. However if you ask 10 employees nobody will say they have a part in it.  Usually they'd say legal owns it or the compliance dept or maybe their manager. It's sad but its the situation for most companies.  When looking at internal compliance it really gets worse.  Most companies really don't have the time or budget to review all internal policies let alone spend the effort to make sure they are enforced.  It's a thankless job. Nobody likes to be scrutinized and even worse being told they aren't doing their job. It's like being in Internal Affairs police officer. You gotta have them but nobody wants to hang out with them. 
The mindset in Health care really should be how the FDA does their process and oversight. That's really the model that its going to.  Products that are developed need to trace to the business specifications traced to the business requirements to functional requirements, etc.  Policies will all need to trace up and trace down.  This also means the administrative workload will increase to ensure compliance(adherence).  Most Health Care companies are going to need to build out their compliance departments from just usually legal to having members with clinical and IT background also. Auditors aren't just going to accounting guys anymore. Companies are going to have to defend how they do business from the top to the bottom level.  Companies need to take a proactive approach to internal compliance.  You need to make folks realize that they do process as a way being more efficient. On the flip side you also need to be open and receptive that if process isn't working you need to fix it. It's a two way street and managers need to understand that.  It's a way to help promote reliable and consistent service to the members that use your health services.  Think of it as eliminating unwarranted variation at the corporate level :)