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Quality Improvement2025-02-20T10:49:30+00:00

Data-Driven Insights. Smarter Care Strategies. Superior Ratings.

Driving Quality Performance to Elevate HEDIS Scores and Star Ratings

For Health Plans, Star Ratings and HEDIS scores are not just benchmarks; they’re critical indicators of care quality and member satisfaction. However, achieving and sustaining high performance requires tackling fragmented data, effective engagement with members and providers, and an ever-evolving regulatory landscape.

The Challenges Health Plans Face in Quality Improvement

Inconsistent Data
Fragmented and Inconsistent Data

Scattered and siloed member & provider data often results in incomplete and stale records, making it difficult to track quality metrics at the population, individual member and provider levels in real-time.

CareOpportunities
Missed Care Opportunities

Care gaps such as unaddressed screenings, unmanaged chronic conditions, or missed follow-ups can hinder quality outcomes, negatively affecting Star Ratings & member satisfaction and most importantly, the health of members.

rating
Regulatory Pressure and Complexity

As measures for Star Ratings and HEDIS performance continue to evolve, staying ahead of requirements demands robust, adaptable Health Data Management Platforms and workflows.

How We Solve It

Enabling Data-Driven Quality Improvements

Our Health Data Management Platform (HDMP) supports clean, reliable, and ready-to-use data that drives impact across all aspects of the care continuum.

Our platform ensures that member & provider data is complete and harmonized through robust Source Data Connectors, advanced Data Processing, and EMPI. This creates a single, reliable Common Data Model from which you can confidently report on quality measures in real-time.
By integrating real-time clinical data directly from providers’ EHRs, HIEs and more, our Health Data Management Platform enables quality teams to leverage more than just claims data when reporting and taking action on specific quality measures in collaboration with providers.
Seamless bi-directional collaboration, both internally across teams and externally with providers is supported, ensuring all stakeholders have the data they need to act efficiently and cohesively, at the right time.

Why It Matters

Improving quality performance impacts every facet of Health Plan success

Increase Member Retention

High ratings attract and retain members.

Enhance Member Outcomes

Close care gaps to deliver better, more timely care.

Ensure Compliance

Stay aligned with regulatory standards and avoid penalties.

Boost Financial Rewards

Quality scores influence incentive payments & contracts for Payers & Providers.

Discover how we address interconnected challenges for Health Plans

Explore More Problems We Solve

Optimize reimbursements with accurate, timely coding.

Health-Management

Enable smarter engagement for better outcomes.

Health-Plans

Balance cost efficiency with care quality.

Elevate Star Ratings and Quality Performance

Empower quality improvement strategies with actionable insights and smarter workflows.

Perspectives by Health Chain

Leveraging Technology Partners to Accelerate Different Stages of the CDI Value Chain

Clinical Data Integration (CDI) offers tremendous value for health plans, but it's a complex process with diverse needs at each stage.

Data Variability and Standardization: Key Hurdles in Effective CDI

Conquer data variability, the biggest hurdle in CDI! Discover how Health Chain's Centaur™ platform tackles data inconsistencies & unlocks actionable insights for better member care & financial performance.

Demystifying the Maze: A Deep Dive into the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) for Health Plans

The Centers for Medicare & Medicaid Services (CMS) finalized the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) in January 2024.

Explore Problems We Help Payers Solve

Problems We Solve
Data Management & Quality
Problems We Solve
Maximizing Risk Adjustment
Health-Management
Problems We Solve
Population Health Management
Health-Plans
Problems We Solve
Utilization
Management
Quality-Performance
Problems We Solve
Quality
Improvement
CMS
Problems We Solve

CMS
Compliance

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