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 solution, Qualit8, identifies gaps in Star Ratings, Quality Rating Systems (QRS), Pharmacy Quality Alliance (PQA) quality measures, state-specific quality measures, and more. Qualit8’s certified engine processes member data against each set of quality measures.
Using advanced analytics and precision targeting, Qualit8 identifies and prioritizes quality gaps to find those most worthy of attention. Qualit8 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, Qualit8 dynamically looks at their history and patterns of behavior to aid in prioritization.
Veradigm’s Quality Analytics solution, Qualit8, 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 patent pending Dynamic Intervention Planning 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.
Qualit8 can help you provide better comprehensive care to your members across medical, dental, pharmacy, and other benefits—and healthier members benefits your health plan.
Monitor, measure, and report on each quality metric using Qualit8’s advanced analytics. Dynamically analyze past 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.
Harness the Qualit8 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 Qualit8’s subject matter experts saves you the expense of hiring your own analyst.
* 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).
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