Case Study
NCQA Health Plan Accreditation Crisis Averted

>>NCQA Health Plan Accreditation Crisis Averted


A regional health plan striving to meet the new NCQA Health Plan Accreditation for Medicare and Medicaid Plans needed to create an online presence to better engage their members in record time.

SDLC Partners quickly developed and executed a plan that created a one stop ‘Member Portal’. SDLC’s team exceeded expectations and came up with a fully compliant solution in less than 7 months while also helping the client receive a 100% NCQA MEM score.

The Challenge

A regional Medicare and Medicaid health plan was faced with meeting new accreditation standards as part of NCQA Health Plan Accreditation. A preliminary internal assessment indicated noncompliance with short runway for development and release.

The health plan lacked an online competitive presence and was required to develop a new member portal within 7 months to meet the compliance deadline.

The Solution

The health plan called upon SDLC Partners to serve as its execution partner. SDLC assisted the client with the development of a ‘Member Portal’ to help support NCQA MEM standards. The portal was to create a seamless member experience through integration with vendors for claims, pharmacy information, health risk assessment and self-management tools. SDLC’s high performing teams collaborated with the client to develop:

  • A scalable platform for usage across multiple lines of business with 3 separate branding themes
  • Browser and device agnostic design to promote member usage
  • Responsive design for a mobile-friendly device experience
  • Partnership in change management (training, vendor contracting and coordination, documentation and go-live support)

The Results

With the help of SDLC, the client released its one-stop ‘Member Portal’ for all health plan and wellness related information. The portal is fully compliant with state and federal regulatory bodies (CMS, DPW and BMS compliance) and supports the NCQA Accreditation. In February 2015, the health plan received a 100% NCQA MEM score. The health plan also exceeded its goal by attaining more than 100 registrations within the first 10 days of its soft launch and has created a self-service request, which can reduce costly member call volume driving down overall costs for the plan.


“With ever-growing customer demands and market competition, it has become paramount that we improve our delivery lifecycle and SDLC has ensured that
we have done that.”

Casi Johnson, Chief Operations Officer/Innovations Leader, M3 Accounting + Analytics