Quality Analytics

Improve Your Quality Scores Using Predictive Analytics and Dynamic Intervention Planning

There are a broad range of quality improvement initiatives available, all of which are aimed at improving your quality scores—but they are far too numerous and far too costly to blindly pursue all of them. Today’s health plans need a data-driven solution to identify targets for closing quality gaps and improving quality scores.

Veradigm’s Quality Analytics (formerly Qualit8) identifies gaps in Star Ratings, Quality Rating Systems (QRS), Pharmacy Quality Alliance (PQA) quality measures, state-specific quality measures, and more. Quality Analytics has certified engine processes member data against each set of quality measures.

• Using advanced analytics and precision targeting, Quality Analytics identifies and prioritizes quality gaps to find those most worthy of attention. Quality Analytics combines proven Quality Improvement Analytics with a National Committee for Quality Assurance (NCQA)-Certified HEDIS® Measurement Certification Program™* to deliver a higher level of value and administrative efficiency. Once members for intervention have been identified, Quality Analytics dynamically looks at their history and patterns of behavior to aid in prioritization.

Harness a Data-Driven Solution to Create Your Most Efficient Workflow

• Leverage our Patented Dynamic Intervention Planning to identify those members with open care gaps who would warrant inclusion in the denominator of each quality metric.
• Identify open care gaps tied to chronic conditions not currently captured in claims and at risk for disease progression.
• Focus your workflow and maximize your efficiency by prioritizing gaps in care according to which gaps will provide the best return for the least effort.
• Generate reports of care gap opportunities in CSV format for easy data processing or visualize directly within the Quality Analytics dashboards.

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Improve Your Quality Scores with Veradigm’s Quality Analytics Solution

Veradigm’s Quality Analytics, applies precision analytics to health plan members to identify those with open care gaps who would warrant inclusion in the numerator of each quality metric. This process applies thousands of codified clinical rules and heuristics primarily based on peer-reviewed, published research. Findings are also adjusted using findings from data mining and modeling based on millions of patient-years of data, based on searches for predictive similarities among members with specific shared conditions. These factors are used to identify additional members who might also share each condition.¹

The patented Dynamic Intervention Planning process incorporates member and provider behavior to prioritize the optimal gaps to target—those gaps that will have the greatest impact. This helps reduce administrative waste and helps health plans understand which members should be prioritized for outreach. Dynamic Intervention Planning empowers you to make the most effective use of your intervention budget, simultaneously saving you money while improving member health.

• Optimize your gap closure workflow for maximum efficiency with precision analytics
• Prioritize quality gaps that will provide the best return for the least effort using Dynamic Intervention Planning
• Improve your quality scores, upgrade patient care, and lower costs by identifying and closing the most effective gaps in care

Veradigm’s Quality Analytics can help you provide better comprehensive care to your members across medical, dental, pharmacy, and other benefits—and healthier members benefits your health plan.

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Optimize Your Performance for Star Ratings, HEDIS®, CMS, QRS, and other Quality Measure Rating Systems

Monitor, measure, and report on each quality metric using Quality Analytics’ advanced analytics. Dynamically analyze history and patterns of behavior to identify and prioritize quality gaps with the patent pending Dynamic Intervention Planning module. Priority scores identify the revenue impact of addressing each different quality metric. Assimilate data to target interventions where they are needed most.

• Gain line of sight into your current performance for Star Ratings, QRS, Medicaid, and other quality measures, with respect to each provider, member, and quality measure.
• Identify your performance potential for addressing those identified gaps in care.
• Maximize your financial impact by targeting interventions according to priority scores.

Improve Your Quality Gap Closure Rate with our Teams’ Subject Matter Expertise

Harness the Quality Analytics team’s subject matter expertise to help you align with HEDIS®, NCQA, CMS, and other quality measures. Optimize your data analysis with strategy sessions with industry experts to help you identify which gaps give you the best return for the least effort and help you identify the ideal intervention method and timeline for closing each of these gaps. In addition, having access to Quality Analytics’ subject matter experts save you the expense of hiring your own analyst.

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* NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA Measure Certification Program™ is a trademark of the National Committee for Quality Assurance (NCQA). HEDIS® is a registered trademark of the of the National Committee for Quality Assurance (NCQA).

References:

1. Pulse8. Analytic Logic: Risk Adjustment Analytics, Financial Reporting, and Risk Mitigation V18.11.0. Accessed March 25, 2021.