    
        Top 3 Areas of Impact    
            
                        Improved Accreditation Performance
                    Achieved NCQA MHC Distinction with a higher score than the previous cycle.
                        Strengthened Health Equity Infrastructure
                    Enhanced SDOH programs, documentation, and evidence collection aligned to future HEA+ requirements.
                        Cross-Functional Quality Alignment
                    Unified teams around clearer processes, reporting, and standards to support ongoing accreditation readiness.

Client Overview

The client is a Managed Care Organization (MCO) that provides high quality healthcare to Medicaid and Medicare members across their state.

Deliverables

Comprehensive Evidence Collection & Submission Package
Gap Analysis & Mitigation Plan
Post-Submission HEA+ Readiness Roadmap

What Drove the Engagement

Challenge

The client required project management support to obtain NCQA Multicultural Health Care Distinction (MHC) certification to meet a state contract requirement. That included providing evidence to meet the standards set for organizations, which includes language services for members and providers, collection and validation of membership race and ethnicity, evaluation of social determinants of health (SDOH programs and reducing healthcare disparities. The client had received the certification previously and needed to enhance their SDOH programs to improve quality metrics and prepare for the transition to NCQA Health Equity Accreditation Plus (HEA+), proving commitment to addressing and closing health gaps in their membership.

Solutions

ProspHire delivered hands-on support to plan and execute collection, packaging and submission of the organization’s evidentiary pieces necessary to meet MHC certification requirements. During this process, ProspHire identified gaps from the previous submission’s documentation compared to the most recent requirements and collaborated with appropriate departments to implement mitigation strategies. Following the submission, ProspHire along with client leadership, analyzed results to develop an execute initiatives to meet the more thorough requirements of the upcoming accreditation.

Impact

ProspHire enabled the client to meet accreditation requirements through identification and development of documented processes, reporting and other key success criteria. ProspHire and the client completed a successful submission and were awarded NCQA MHC Distinction, with an improved score from the previous submission. These efforts built a solid foundation for HEA+ Accreditation while demonstrating that the client provides strong health equity programs for their members.