For Health Plans, Practices, SNPs & ACOs
From readiness through submission, and the operational work that follows.
We help you build the operation to achieve your regulatory goals. Success requires strategy, accountability, clinical readiness, operational discipline and scalability.
KHS helps healthcare organizations translate requirements into sustainable capabilities, from initial assessment through implementation, readiness testing, and submission.
NCQA or URAC accreditation preparation, guidance, and implementation, guiding your plan through to successful submission.
Achieve or renew NCQA PCMH Recognition by translating requirements into sustainable care delivery, quality improvement, and operational processes that support recognition and value-based performance.
Assess health plan MOC readiness, draft MOC templates, identify CMS audit gaps, and manage off-cycle MOC updates and submissions.
Build or strengthen case management capabilities for NCQA accreditation, including current-state assessment, program design, policies and workflows, clinical tools, implementation readiness, evidence strategy, and mock survey support.
The KHS Difference
You work directly with experienced leaders who have built, operated, overseen, and evaluated these programs within CMS, NCQA, and regional and national health plans.
Senior leaders serving as trusted advisors.
Focused assessment, recommendations, and execution.
Experienced capacity embedded with the client team.
A healthcare services organization engaged KHS to establish a new complex case management capability and prepare for first-time NCQA Case Management Accreditation. KHS assessed current-state capabilities and accreditation gaps, facilitated design of the clinical and operational model, and developed the foundational program framework, including population identification and stratification, engagement, assessment, care planning, interdisciplinary care, performance measurement, and governance. As the client transitioned to implementation, KHS shifted to an advisory and readiness role, providing critical review, accreditation guidance, and preparation for mock survey activities.
Support new and renewing SNPs in developing, strengthening, and operationalizing their Models of Care. KHS helps organizations assess readiness, interpret CMS and NCQA requirements, develop and review MOC documentation, align operations with the approved model, prepare for submission and off-cycle updates, and assess CMS audit readiness.
KHS helps practices prepare for initial or renewal NCQA PCMH Recognition by assessing current capabilities, identifying gaps, and translating PCMH requirements into practical clinical and operational processes. Support may include transformation planning, policy and documentation review and development, quality measurement and improvement, care management and coordination processes, evidence preparation, submission support, and readiness for NCQA review.
KHS helps ACOs, provider organizations, and delegated entities understand how their patient care operations align with a health plan’s SNP Model of Care requirements. Services may include operational readiness assessment, identification of capability gaps, performance and key performance indicator development, and preparation for delegated or value-based arrangements.
Whether it’s a first-time submission, a renewal, or a care management program that needs a stronger foundation, readiness rarely means what people assume it means.
KHS assesses where the gaps actually are, builds toward accreditation, and stays with you through submission.
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