Nolan Practice Review 360: Align Health Management

In the normal course of business, health plans add capabilities and modify processes to deliver products and services more efficiently and effectively. All too often, however, these organizations fail to consider the compliance implications of modifying their health management programs — only to find those programs have become out of alignment with compliance requirements over time.

The Nolan Approach

The Nolan Company has developed a comprehensive compliance approach, Nolan Practice Review 360: Align Health Management, which has captured many of the typical requirements (e.g. HEDIS, URAC, NCQA) that apply to health management programs.  Our profiling tools allow areas that are non-compliant, or at risk for becoming non-compliant, to be quickly identified and remediated. Our approach also includes Service Management and Process Maturity frameworks that allow compliance activities to be designed into day-to-day operating procedures so that once programs are brought into compliance they will remain compliant over time, even as requirements evolve.  Our Service Management framework also provides a Compliance Module that will allow requirements to be defined and monitored in a manner that can turn compliance audits into “non-events.”

Reap the Benefits

Because we’ve already captured many of the key compliance requirements and defined tools and frameworks for assessing, achieving, and maintaining compliance, organizations can efficiently address compliance needs. Because our model focuses on aligning health management programs with compliance requirements as well as providing an approach for maintaining compliance, organizations can be confident that the resulting compliance model is comprehensive and will persist into the future.