Health plans of all sizes face mounting pressure to keep up with ever-changing quality, healthcare compliance, regulations, accreditation standards. Health organizations must be able to assess and create mining systems for data management, document the accuracy of care achieved (when, where, how), in order to meet standards and metrics for organizations such as NCQA, CMS, Joint Commission, URAC and others. Not being compliant or not meeting the goals can lead to a shift in operation efficiencies, possible penalties and no bonus.

Data visualization via audits on a regular basis will keep organizations in compliance with meeting goals and objectives. Seeking a sustainable, data-driven approach to improving compliance helps to address opportunities and gaps in real-time. Organizations with an alert leadership team, will be agile in creating strategies and planning processes to address compliance, quality, and data analytic concerns.

D’Wellington areas of focus in staying abreast:

• Analyzing member records to identify gaps in reporting and compliance adherence

• Developing a structured workflow to ensure seamless documentation for audits

• Training staff on quality and regulatory protocols to align with accreditation bodies (i.e. CMS NCQA, Joint Commission, URAC, and more)

• Implementing data tracking systems for real-time performance monitoring

• Continuous quality improvement (CQI) processes will help with streamlining your compliance, quality, audits and regulatory deadlines.

By integrating data analytics tools, visualization concepts and automated reporting tools, the organization can reduce duplicity, improve documentation accuracy, patient safety with greater productivity.