History of QMetrics
QMetrics, Inc. is an independent audit and consultancy group founded in 2006. We are not a large consulting house nor strive to be one. We are a boutique consulting firm with the sole goal of providing tailored, individualized services to a select group of clients. We pride ourselves in knowing the unique situation and needs of our clients allowing us to build long standing bonds with our client partners. Our clients consider us to be the agile “go-to” experts that they can count on.
Our focus is grounded in a strong working ethos based on building trusted relationships. We consider quality, accuracy, efficiency, and innovation in all we do. Our perspective has always been; “how do we complete the task at hand and provide relevant education, best practices, and insightful feedback to organizations and help them grow and improve.” We don’t just check a box for completion, we “think outside the box” and go above and beyond the scope of work to provide maximum value. We put ourselves in our partners shoes and consider, “what all can we do to make this process or outcome better.”
Our team has over 80 combined years of experience across the full spectrum of managed care; working in health plans, consulting for health plans, overseeing and auditing health plans. We understand the unique challenges, barriers, and requirements providers and health plans face. In addition to this deep understanding of the operational aspects of health plans and provider organizations, we know how to ensure compliance with National Committee for Quality Assurance (NCQA), State, and other regulatory agencies.
Our founder, Suzan Mora Dalen, MPA, CHCA has been a HEDIS auditor since 2005 and has performed over 300 audits across the country covering HEDIS, CMS data validation, and Pay for Performance. She has over 25 years of healthcare delivery experience in the health plan, medical group, and hospital settings. Her leadership and management background include quality management, provider credentialing, network management, delegation oversight, data validation, and encounter data management and reporting. Mrs. Dalen holds a Certified HEDIS Compliance Auditor certification from the National Committee for Quality Assurance (NCQA).
Our Chief Health Economist, Jim Dalen, MA, is a former Certified HEDIS Compliance Auditor and has performed more than 70 HEDIS and Performance Measure Validation audits across the country. He has developed numerous value propositions, ROI models, and statistically based predictive models targeting many facets of managed care. Mr. Dalen has over 30 years’ experience in managed care and is a known subject matter expert in Dual enrollment, advanced analytics, predictive modeling, risk score evaluation and improvement. Mr. Dalen has been a frequent lecturer at managed care conferences on these topics for many years.
Our Chief Compliance Officer & Senior VP Regulatory Affairs, Stacy Baker, JD, has over 15 years’ experience implementing both state and federal statutory and regulatory provisions and sub-regulatory guidance. She has managed all aspects of health plan operations with delegated entities to ensure compliance with new and existing laws. Her primary expertise is California.
Our programming & analytics division, reporting to our Chief Health Economist, has many years of experience working with and reporting health plan professional and institutional data. Our team is intimately familiar with the disparate array of idiosyncrasies in managed care data, we are well versed in data validation and preparation to support rigorous analysis and insightful reporting. Our team has worked with a wide variety of data systems, data types, and risk adjustment models over the years.
Our clients, partners, are health plans, provider organizations, and other health care industry stakeholders. Our objective is to help our partners stay in full compliance with NCQA, State, and other regulatory agency requirements while leveraging these activities to improve services and care provided to members and patients.
QMetrics is a California Association of Health Plans (CAHP) affiliate member and is a California Certified Small Business (#2009743). We are proud to have had a presence in the State of California since 2006.
QMetrics is a minority woman-owned business pending federal 8(a) certification.
MPA, CHCA, Founder, Principal & HEDIS Auditor
A Certified HEDIS® Compliance Auditor since 2005, Ms. Dalen has performed over 200 National Committee on Quality Assurance (NCQA) HEDIS® Commercial, Medicaid, and Medicare compliance audits as well as Centers for Medicare Services (CMS) Data Validations reviews. Additional work include California’s Integrated HealthCare Association (IHA)’s Value Based Pay for Performance audits and consultancy work in the area of quality and performance improvement for health plans, medical group, and hospitals. Ms. Dalen holds a Master’s of Art degree in Public Administration with a focus on healthcare administration.
MA, Chief Health Economist
Responsible for analytical reporting design, statistical analysis, and oversight. As a previous HEDIS® auditor, Mr. Dalen performed HEDIS® audits and performance measure validation reviews across the country. Mr. Dalen has developed value propositions, ROI models, and statistically based predictive models targeting multiple aspects of managed care. Mr. Dalen also has devoted many years to developing standard analytical methods and reporting processes for HEDIS® and CAHPS®. Mr. Dalen was responsible for all survey research and statistical analysis in a health plan setting. Mr. Dalen holds a Master’s of Arts in Economic Theory and Econometrics with a focus on health care economics and health policy.
JD, Chief Compliance Officer & Sr. VP Regulatory Affairs
Ms. Baker earned her J.D. from the University of San Diego School of Law and has been working in the regulatory compliance field for over 15 years. Ms. Baker served as the Director of Legislative & Regulatory Affairs and Medicare Compliance Officer at Sharp Health Plan for the past 10 years. Stacy has extensive experience interpreting and implementing both state and federal statutory and regulatory provisions and sub-regulatory guidance. Ms. Baker has served as the primary health plan liaison to numerous regulatory bodies including the California Department of Managed Health Care (DMHC), Covered California, CMS, the Department of Labor and CCIIO. Ms. Baker has worked closely with all aspects of health plan operations and delegated entities to ensure compliance with new and existing laws impacting health plan operations and is keenly familiar with the impact on those health plan operations.