Frequently Asked Questions
Q: What is performance improvement in health and human services?
A: Performance improvement in health and human services is part of quality management, which applies a systematic approach to identifying gaps between current and desired outcomes, analyzing root causes, and implementing data-driven changes to improve quality, efficiency, compliance, and client outcomes. It encompasses quality management programs, HEDIS and CAHPS measure improvement, care gap reduction, incident investigations, and continuous process improvement cycles.
Q: How does Hess III Consulting build quality management programs?
A: Hess III Consulting builds quality management programs from the ground up or refines existing programs by first identifying regulatory requirements, best practices, and agency goals. We then define the quality program structure, workplan, data systems, and monitoring mechanisms. Ongoing, we support program monitoring, auditing, data visualization, root-cause analysis, and rapid cycle improvement projects.
Q: What quality standards does Hess III Consulting work with?
A: We work with nationally recognized quality standards and frameworks including NCQA accreditation requirements, AHCCCS and CMS quality requirements, HEDIS measures, CAHPS survey requirements, Joint Commission standards, National Outcomes Measures, Health Research and Services Administration (HRSA) Standards, and state behavioral health quality reporting requirements.
Q: Can Hess III Consulting help with critical incident investigations and auditing?
A: Yes. We provide program monitoring and evaluation services including auditing and critical incident investigations. We help organizations meet regulatory investigation requirements, conduct thorough root-cause analyses, develop corrective action plans, and implement systemic improvements to prevent recurrence.
Q: How do LEAN and Six Sigma support performance improvement in health and human services?
A: LEAN and Six Sigma are complementary methodologies that drive measurable performance improvement. LEAN identifies and eliminates non-value-added activities (waste) in clinical and administrative workflows, while Six Sigma uses statistical analysis to reduce process variation and defects. Together, they provide a structured, data-driven approach to improving quality measures (HEDIS, CAHPS), closing care gaps, reducing documentation errors, shortening cycle times, and ensuring consistent service delivery. Hess III Consulting integrates LEAN Six Sigma with Agile and PMI frameworks to deliver rapid, sustainable improvements tailored to health and human service operations.
Q: How does performance improvement support program integrity?
A: Program integrity refers to ensuring that Medicaid and other publicly funded programs pay the right amount, to the right provider, for the right services delivered to eligible members. Performance improvement supports program integrity by building standardized workflows, documentation controls, and monitoring systems that prevent errors before they occur, detect anomalies early, and produce reliable data for audits and oversight. Quality management programs, root-cause analyses, and rapid cycle improvement projects all reinforce the controls that protect program integrity.
Q: How can performance improvement help address fraud, waste, and abuse (FWA)?
A: Performance improvement reduces fraud, waste, and abuse by strengthening the underlying processes where FWA risks emerge. LEAN eliminates wasteful steps and redundant services that drive unnecessary spending. Six Sigma reduces billing and coding variation that can result in improper payments. Structured quality monitoring, internal auditing, and data analytics surface outlier patterns — such as unusual billing frequencies, documentation gaps, or service utilization anomalies — that may indicate fraud or abuse. Combined with corrective action planning and staff training, these methods build a culture of compliance while improving efficiency.
