Healthcare Consulting Services

The Mihalik Group (TMG) assists health care organizations with all accreditation-related activities in order to improve health care quality. Our clients include both governmental and non-governmental health care organizations including:

• Medicare, Commercial, Medicaid, and Marketplace Health Plans;
• Managed Behavioral Health Care Organizations;
• Dental and Vision Service Providers;
• Long Term Support Service Providers;
• Integrated Health Care Networks;
• Hospitals and Ambulatory Care Providers;
• Pharmacies;
• Pharmacy Benefit Management Organizations;
• Pharmaceutical Companies;
• International Health Care Ministries.

Our consulting team has years of experience in National Committee for Quality Assurance (NCQA), The Joint Commission (TJC), Utilization Review Accreditation Commission (URAC), Joint Commission International (JCI) and Accreditation Association of Ambulatory Health Care (AAAHC) consulting. TMG has assisted over 50 health plans in achieving and maintaining NCQA accreditation as well assisting hundreds of Health Care Organizations with The Joint Commission survey over the last 20 years.

TMG’s process for a successful accreditation includes a readiness assessment, development of a robust roadmap, assistance with meeting compliance on critical documents/requirements, and streamlining operations so they exceed requirements and adhere to best practices established by the industry.

The Mihalik Group’s (TMG) team of quality improvement consultants works exclusively within the health care industry. Our consultants have first-hand knowledge of the challenges involved in designing, implementing, monitoring and evaluating quality management and improvement programs.

TMG’s expertise is available in a full spectrum of arrangements tailored to meet your unique needs, including:

• Full management of quality improvement programs
• QI program design, implementation and evaluation of effectiveness;
• Assistance with development of committee structure and functions;
• Review of the adequacy of committee agendas and minutes;
• Management of committee meetings and writing of minutes;
• development of indicators, measures and quality improvement activities;
• Development and presentation of quality improvement activities, including narratives and graphs;
• Statistical analysis of measurement activities;
• Assistance with development of practices in support of continuity and coordination within and between general medical care and behavioral health care;
• Evaluation of organizational standards for availability of providers and accessibility of services and related measurement processes;
• Education and training on the principles, tools and techniques of quality improvement;
• Review of communication practices with stakeholders;
• Development of provider and member communication materials.

TMG's consultants have worked with a wide variety of Health Plans to improve HEDIS/CAHPS/Star ratings over the last 15 years. They have built long-term solutions that address the root cause of the problems. Some examples include initiatives to improve encounter data collection and provider report cards and incentive programs, and member outreach/incentive programs. These programs have resulted in significant improvements in HEDIS measures over the years. HEDIS consulting services are available to meet any HEDIS need from setting up HEDIS reporting and data collection services to sophisticated analysis to identify members most likely to affect ratings and applying robust interventions for this targeted population.

TMG's HEDIS team includes:

• Analysts with over 15 years of experience in analyzing HEDIS, CAHPS, and HOS.
• Project leads and managers with over 15 years of experience in managing HEDIS collection and abstraction projects.
• Technical experts with experience in using and enhancing HEDIS software applications.
• Registered and licensed vocational nurses and certified clinical coders with HEDIS medical record abstraction experience.
• Information technology professionals with experience in evaluating, programming, and developing system solutions.

Our consultants work to develop solutions targeted at improving the following areas critical for improving HEDIS/CAHPS/Star Ratings:

• Organizational goals and strategic direction;
• Operational strategy;
• Engaging members;
• Engaging providers;
• Data collecting and reporting solutions;
• Medication compliance.

The Mihalik Group is highly experienced in creating educational programs that provide innovative and long-lasting educational solutions. Following the conclusion of a unique needs assessment, TMG works closely with each organization to design comprehensive educational content that utilizes the most current thinking and deliver a program that ensures understanding of the standards and the requirements for meeting them.

Each program will utilize a variety of media and delivery methods tailored to fit organizational infrastructure and culture and is supplemented by informal one-on-one and small group sessions and training throughout all consultative activities.

Educational programs cover topics such as:

• NCQA and TJC standards and surveys;
• The NCQA and TJC survey process;
• Quality improvement tools and techniques;
• How to implement best practices and quality improvement projects.

TMG’s educational faculty has unsurpassed credibility coupled with outstanding speaking skills resulting in motivating and interactive programs that maintain the attention of staff at all levels.

While education program components are targeted for the greatest impact, every effort is made to include as many staff members as possible. Organizational leaders are expected to participate in as the initiation of the survey preparation process, it is recommended that as many staff members as possible attend the program. It is critically important that organizational leaders participate given the impact that survey preparation will have on the organization.

TMG’s team of UM consultants have vast experience in both clinical and health plan settings. Our expertise in this arena will help guide your organization’s UM program in dealing with accreditation, compliance and achieving operational excellence.

Our team will help create an action plan specific to your organization’s needs, including but not limited to the following:

• Full operational management of UM program;
• Development of a UM program design;
• Support with implementation and evaluation of effectiveness of UM program;
• Involvement of appropriate UM professional expertise;
• Achieve operational efficiencies by applying industry best practices;
• Development of a UM dashboard to track key operational indicators;
• Assist in developing committee structure and functions;
• Participation in committee meetings and assist in writing of minutes;
• Ensure continuity and coordination of care between medical and behavioral services;
• Review of communication materials including approval and denial letters;
• Development of reports with analysis and recommended action plan for key performance metrics such as: overutilization, underutilization, top spend in medical and pharmacy, etc.

A successful NCQA submission requires a very coordinated, collaborative, and sometimes complex approach. It is an enormous effort on the part of our clients to ensure all the documents (i.e. P&Ps, reports, materials, etc.) are completed, tagged, and submitted to NCQA in a timely manner. TMG, for years, has been supporting a number of clients in this process and now is offering this as a service to assist new clients on an ongoing basis.

The NCQA Project Manager will focus on managing all the activities related to NCQA submission.

The NCQA Project Manager:

• Develops a robust workplan with tasks, deadlines, responsible personnel, etc.
• Updates the workplan on an ongoing basis to ensure tasks are completed in a timely manner.
• Updates leadership on the status of the tasks on a weekly basis.
• Has bi-weekly check-in meetings with the business owners to ensure tasks are completed as planned.
• Collaborates with leadership and business owners to develop new and maintain policies and procedures as needed.
• Ensures completion all NCQA policies and procedures in a timely manner.
• Coordinates completion of materials and follows up with business owners to ensure materials are sent in a timely manner.
• Assists the team in preparation for the IRT submission (i.e. tagging, uploading, linking, etc.) and onsite review.
• Develops the first draft of all the reports needed for NCQA accreditation.

TMG’s team of seasoned project managers offers a suite of mature project management solutions to lead general business and information technology projects. Typically, client executives utilize TMG’s project managers to execute organizational transformation projects that will fundamentally improve operational efficiency at the intersections of people, process, and technology. TMG’s project managers have deep experience performing the following functions:

• Project Business Cases – Research and develop business cases for projects that includes defining the problem statement, exploring potential solutions, performing cost benefit analysis and return on investment analyses; this often includes supporting client executives in obtaining board approval for projects with PowerPoint presentations that explain and justify the project investment.
• Stakeholder Analysis – The stakeholder analysis is a critical component for large scale enterprise transformation projects. The stakeholder analysis assesses who is impacted and how. This analysis serves as the basis to manage organizational change and identify strategies to overcome barriers and/or resistance to change. The stakeholder analysis can be both internal and external.
• Ongoing Project Management - The purpose of this is to drive cross-functional team dialogue about issues, risks, action items, and decisions. These meetings serve as a time for the team to collaborate on resolving the most pressing or challenging aspects of the project tasks and deliverables.
• Business Decision Facilitation – A number of TMG’s clients have faced challenges making business decisions regarding technology platforms, selecting partners, or assigning ownership of business functions to the appropriate business units. TMG’s skilled project managers have a process to research the pros and cons of various solutions and obtain organizational buy-in on a particular path. TMG’s project managers can facilitate these business decision discussions and document the organizational context for when, why, and how certain decisions were made.

Types of projects managed in the past include, but are not limited to, the following:

• RFP Procurement
• System Implementation
• Vendor/Partner Transitions
• Business Process Improvement
• Organizational Redesign
• Regulatory/Compliance