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NCQA Accreditation Pitfalls: Staffing the Compliance team.

                I’m going to pretty blunt on this topic, just grabbing any old clinical person and putting them in charge of NCQA accreditation for either your Health Plan or DM organizational is a recipe for disaster.  That might have worked 4 years ago where the standards where much easier but not anymore.  NCQA requirements have become increasing technically, with considerable emphasis on legal concerns.  The clinical part of the accreditation is really 1/3 of it with another 1/3 being IT and legal and the rest being Quality initiatives (with heavy emphasis on performance measurements).  Unless your Clinical lead has a technology background you’ll have issues.  The ideal team really is having a clinical member and IT member (preferably a technical analyst) and a compliance/legal member.  My background is IT/Compliance and I have a clinical person on staff. We actually complement each other pretty well and cover most areas. I am never surprised on how little the health plans understand about NCQA requirements. We usually find ourselves answering Health Plan questions on their own NCQA Accreditation. Internally we spend a lot of time answering product/sales questions. Our work does branch into performance and HEDIS measures also.A lot of questions arise with CMS and HHS questions. In some ways you end up being the sage of all things accreditation related.  It's an interesting segment to work in. Most organizations have legal staff to handle "compliance" but that tends to be contracts and legal. Clinical staff handles programs and IT staff handles infrastructure but who puts it all together in a complete package and make sure the varied organizations complete their regulatory and accreditation goals? Just tooting my own horn here, it's the compliance team.  You really need to ask the questions of who, what and why.