Healthcare program development consulting

What does program development include?

The work falls into three families, each linked to its service pages.

Credentialing programs and credentials verification organizations (CVOs)

Credentialing program design builds the written process an organization uses to verify, review and re-review practitioners. CVO design builds the operation that performs primary source verification for others, including workflows, data management and quality checks.

• Credentialing program design and build-out
• Credentialing program design FAQ
• Credentialing program design comparison
• Credentialing program design cost guide
• CVO design for NCQA CVO Certification
• CVO FAQ
• CVO comparison
• CVO cost guide

Certificate of need applications

A certificate of need (CON) application asks a state to approve a new facility or service before it is built or offered, in states that have CON laws. IHS drafts the application text, and your organization files it.

• Certificate of need application consulting
• CON application FAQ
• CON state tracker

AI governance programs

An AI governance program sets who approves, validates, monitors and answers for each AI tool a healthcare organization uses, and how the organization shows it did so.

• AI governance program development
• AI governance FAQ
• AI governance framework guide
• AI governance regulatory tracker

What triggers a program build?

A build starts when something requires a program that does not exist yet. Each trigger below quotes or summarizes the authority’s own text, opened on the date shown. Where the text is silent or the application to your case is IHS’s reading, the page says so.

A regulation requires a written program you do not have

Medicare Advantage organizations are one example. The rule says: “Adopt and implement an effective compliance program, which must include measures that prevent, detect, and correct non-compliance with CMS’ program requirements as well as measures that prevent, detect, and correct fraud, waste, and abuse.” (42 CFR 422.503(b)(4)(vi), read 2 October 2026.) IHS’s reading: where no such program exists yet, the work is a build, not a gap review. Building a compliance program sits with compliance program development.

A rule requires written credentialing policies

The same part of the Medicare Advantage rules says: “An MA organization must have written policies and procedures for the selection and evaluation of providers.” It also requires a documented process for physicians and other health care professionals that covers “Recredentialing at least every 3 years that updates information obtained during initial credentialing,” among other elements the rule lists. (42 CFR 422.204(a) and (b)(2)(ii), read 2 October 2026.) See credentialing program design.

A standards body will evaluate an operation you are about to start

NCQA’s CVO FAQ page presents CVO Certification as NCQA’s evaluation for credentials verification organizations (NCQA CVO FAQs, page opened October 3, 2026). IHS’s reading: an organization that wants that evaluation first needs a verification operation to evaluate. See CVO design.

A state requires approval before you build or offer a service

North Carolina’s statute opens: “No person shall offer or develop a new institutional health service without first obtaining a certificate of need from the Department,” and then adds a narrow proviso (N.C. Gen. Stat. 131E-178(a), read 2 October 2026). The statute defines “new institutional health service” in N.C. Gen. Stat. 131E-176 and lists exemptions from review in 131E-184, so whether a given project needs a certificate of need turns on those provisions. Other states have their own laws, so check yours. See certificate of need applications.

You adopt a tool your legal duties already reach

The federal nondiscrimination rule for health programs says: “A covered entity must not discriminate on the basis of race, color, national origin, sex, age, or disability in its health programs or activities through the use of patient care decision support tools.” It adds that a covered entity “has an ongoing duty to make reasonable efforts to identify uses of patient care decision support tools” that use those variables (45 CFR 92.210(a) and (b), read 2 October 2026). The rule reaches a “covered entity,” which 45 CFR 92.4 defines to include a recipient of Federal financial assistance. On 2 June 2026 HHS published a notice that a court vacated parts of the 2024 rule to the extent they expand sex discrimination to include gender identity. Section 92.210 is not among the provisions that notice lists (91 FR 32887). IHS’s reading: an organization using such tools needs a governing program to do that identifying. See AI governance programs.

How does IHS deliver a program build?

IHS drafts the program, policies and clinical content for your clinicians to review and approve. The work runs in five steps.

1. Identify the governing text: the standard, regulation or contract that requires or shapes the program, and the version in force.
2. Set the program architecture: scope, owners, committees, workflows and the documents the program needs.
3. Draft the policies, procedures, workflows and clinical content, each mapped to the governing text.
4. Your clinicians and governing body review, change and approve the drafts.
5. Hand over a readiness checklist: what the program would need to show a reviewer later, whether that is an accreditor, a regulator or a payer.

What does a program build cost?

The cost has three parts: fees set by the body that reviews or approves the program, your own staff time, and the consulting fee. The body involved, whether a state agency or an accrediting body, sets the first part. Where that body publishes its fees, verify them there before budgeting. Where it publishes none, your organization asks the body for the figure. The second part depends on how many clinicians, committees and systems the program touches. IHS sets a fixed fee for each engagement after a free discovery session, because scope, number of sites and the standards involved change the work.

Cost guides: credentialing program design and CVO design.

How do the three practice lines fit together?

IHS has three practice lines. Program Development builds a program that does not exist yet. Accreditation Consulting takes an existing program through a named accreditation standard. Compliance Services keeps an existing program aligned with changing requirements. A common order is build, then accredit, then monitor.

Two neighboring pages sit with Compliance Services and are cross-links here, not part of this line: compliance program development, which builds the compliance program itself, and regulatory readiness and gap assessment, which tests an existing program against a requirement. Related: compliance program FAQ, readiness gap FAQ and all IHS services.

Frequently asked questions

What is healthcare program development?

Healthcare program development is building a program from scratch under a standard, regulation or contract. IHS drafts the policies, procedures, workflows, quality system and governance that the program did not have before, and your clinicians review and approve them.

How is program development different from accreditation consulting?

Accreditation consulting takes a program that already exists through a named accreditation standard. Program development builds the program itself, before any accreditor reviews it. Some organizations build first and decide on accreditation afterward.

What starts a program build?

A build starts when a regulation or contract requires a written program you do not have, a state requires approval before a new service, a standards body will evaluate an operation you are about to start, or you adopt a tool your legal duties already reach. The triggers section cites the source for each.

Who writes the policies and clinical content?

IHS drafts the program, policies and clinical content for your clinicians to review and approve. Your organization owns the final text and the decision to adopt it.

Who submits the application and deals with the regulator or accreditor?

Your organization's named contact submits, and IHS drafts the text. IHS is not an accrediting body and does not grant or influence any accreditation, certification or licensing decision.

Who leads NCQA work at IHS?

Maureen Plumstead leads NCQA accreditation and recognition engagements. Dr. Goddard leads NCQA program development, such as designing a credentialing program.

How much does a program build cost?

The cost has three parts: fees set by the body that reviews or approves the program, your own staff time, and the consulting fee. IHS sets a fixed fee for each engagement after a free discovery session, because scope, number of sites and the standards involved change the work. Where a state or accrediting body publishes its fees, verify them with that body before budgeting. Some bodies publish no schedule, and then your organization asks the body for the figure.

Which IHS practice line fits my situation?

Choose Program Development when the program does not exist yet. Choose Accreditation Consulting when it exists and you are working toward an accreditation decision. Choose Compliance Services when it exists and you need to keep it aligned with changing requirements. An organization can need more than one, in that order.

Who is this not for?

Program development is not for an organization whose program already exists and needs only an accreditation decision, which is accreditation consulting. It is not for an organization that wants IHS to file with a regulator or accreditor for it, or to give a legal opinion. IHS does neither.

Talk through your build

A discovery session scopes what the program needs, what governs it and what your team has to approve.