LYNNE JETER

Because Florida requires NCQA accreditation for commercial and Medicaid HMOs to retain licensure, compliance is a hugely draining expense with no singular system used by all HMOs.

ComplyPath™, the first regulatory compliance system to be developed in collaboration with the NCQA, has just come onto the market to help Florida’s managed care organizations.

“We’ve taken the under-automated compliance process and have created a fully supported solution to make audit compliance and preparedness streamlined, seamless and available for standards across the enterprise,” explained Steven Lefar, president of MediRegs, a provider of risk and reimbursement management solutions that partnered with Top Tier Consulting on the project. “Unlike other systems that merely house the high level standard, this solution includes detailed question sets derived from the standards, action plans and self audit surveys that are useable by line employees providing leverage to the accreditation and risk management process. If you’re looking for a way to make the NCQA compliance process easier, (this) offering will go a long way to streamlining and simplifying an often tedious and costly process for health plans.”

Greg Anderson, one of the developers of ComplyPath, and a Top Tier Consulting partner, pointed out no other comprehensive regulatory solution like ComplyPath exists.

“The ComplyPath Solution brings a bundled set of technology and software, pre-loaded content, pre-configured settings in a hosted service along with a team of experienced regulatory compliance professionals to assist accredited health plans with this important and complex regulatory task,” he said. “The ComplyPath Solution solves the complexity of the regulatory compliance process from initial development through maintenance and audit preparedness by automating the project management component, providing a source for state, federal and Medicare regulations and NCQA standards and providing storage, organization and version control of documents.”

MediRegs and Top Tier Consulting provide the NCQA standards in their compliance database, as well as a risk management tool based on the standards in their ComplyTrackTM for Health Plans. In addition, MediRegs risk assessment tools include templates to assess adherence to the Medicare Monitoring Guide for plans, Part D, Deficit Reduction Act and numerous general areas including governance, human resources, information systems and privacy. Future plans include a link to the NCQA Interactive Survey System (ISS) to eliminate duplication of effort by enabling health plans to not only upload standard compliance but to upload all related documentation and information collected throughout the regulatory compliance process.

Anderson said ComplyPath saves managed care organizations considerable time and money by using technology to assess risk, identify actions and manage documents in a more efficient manner, resulting in fewer staff hours; providing templates and tools for policy and procedure writing, thus eliminating starting from “scratch” on this very large task; and providing leadership and tools for workflow development and process improvement, resulting in timely and effective change, eliminating waste in time, process and resources.

“The solution stays updated with constantly evolving regulatory requirement changes, so no human resources are spent on cumbersome research and updates,” pointed out Anderson, adding that ComplyPath is a single source for reporting … and tracking all compliance gaps and activities, eliminates redundancy and re-work. “Regulations are cross-referenced between agencies to streamline the creation of policies and process development. Extensive compliance and audit knowledge coupled with experience means less training of internal staff and minimal time on the learning curve.”

MediRegs already provided regulatory and compliance databases to regulatory professionals throughout the national healthcare industry, and Top Tier Consulting provided healthcare consultants with extensive experience in strategy, operations, IT, medical management and regulatory compliance. The two organizations identified an opportunity for growth in the health plan industry by incorporating accreditation standards in the MediRegs ComplyTrack tool. NCQA was identified as the primary accrediting organization and the Managed Care Organization Standards were targeted. A working relationship with NCQA was fostered and a contract signed between MediRegs and NCQA for use of the standards and supporting documentation, said Anderson.

“Our mission was to develop a collaborative relationship and contract for the use of NCQA standards and supporting data that would enable health plans to fulfill their compliance requirements in the most efficient way,” explained Anderson. “Bottom line: we can help management meet their compliance requirements faster, cheaper and better.”



August 2007