An effective Quality analytics and technology vendor can be invaluable to any health plan. They can help identify members with open care or Quality gaps, providing plans with opportunities to close these gaps and improve Quality assessment scores such as your Healthcare Effectiveness Data and Information Set (HEDIS®) numbers or your Centers for Medicare & Medicaid Services (CMS) Star Rating.1, 2
However, it can be difficult, even overwhelming, to select a new vendor—or to determine if your current vendor is meeting your needs.
Your goal is to identify a vendor who can not only help you identify Quality gaps that you can close, but a vendor who can also help you prioritize which gap to address first. Which gap will be the most effective and the most cost effective to close? That’s why we have compiled this list of questions you should ask any Quality analytics and technology vendor, whether you are evaluating your current or shopping for a new one. Their answers will help you assess whether their goals, priorities, and expertise meet your individual needs.
Prioritize a supportive relationship
Question 1. Do you offer full customer support for your end-to-end solutions?
For a Quality analytics and technology company to be successful, it must do more than just supply Quality analytics. They need to support their clients as they interpret the analytics dashboard, to ensure that they get optimal value from their tools. They also need to support their clients as they interpret the analytics data, some of which requires significant subject matter expertise to understand. Clients often require support to enable them to identify and compare opportunities, so they can judge which Quality or care gaps will be most effective to address first.
Some vendors charge adjustable rates for their solutions and provide support for different options in an a la carte fashion. More than one vendor market their services for implementation, training, and data services using variable pricing.
At Pulse8 our top priority is helping our customers close Quality and care gaps and, ultimately, improve their HEDIS® performance and CMS Star Ratings through our end-to-end solutions. We work directly with clients to ensure that they get what they need to identify those gaps that will be most profitable for them to address. We optimize for what each customer needs and educate our staff so they can fine-tune the support they provide. Customer support is integral to everything we do because we believe success requires a supportive client/vendor relationship—without any unexpected upcharge.
Question 2. Do you prioritize accuracy and transparency in the Quality analytics you provide?
For a client to successfully close Quality gaps, they need to be provided with information that is trustworthy, visually compelling, and action focused. You also want information that is tailored to your individual needs, so you can compare the value of addressing different Quality gaps and prioritize which course of action will best help you meet your goals.
Many vendors will state that they prioritize transparency. However, when they deliver a target list, its origin may be a black box. For instance, it might list people who should receive Individual Health Assessments—but fail to rank their values and fail to provide granular details such as confidence levels, financial values of the gaps, and so on. Or they might provide a lengthy list and argue that you can bump up your numbers if you perform more chases but leave out the specific values of individual targets.
At Pulse8, we provide this sort of list complete with the information you need to make informed decisions, information that enables you to target the right interventions, to the right members, to close the right Quality gaps, at the right times.
Question 3. What data do you share with clients to help them make decisions?
Every Quality analytics and technology product generates output files in addition to the visual dashboard, but not every vendor passes those files along to the client. It goes back to transparency. When you’re making decisions about which Quality gaps to address, you need to know that you can trust the numbers you’ve been given. To trust those numbers, you need to know their source.
At Pulse8, we provide our clients with those output files, allowing them to compare our numbers with their own. Clients are empowered to view the source data behind every visual dashboard and can use any or all the data we generate to conduct their own studies and utilize it however suits their business needs.
Prioritize relevant experience
Question 4. What Quality analytics experience do you have in all lines of business (LOB)?
Health plans know that each LOB is unique. Since different LOBs will have different Quality needs to address, you need a vendor who recognizes the challenges unique to each individual LOB. However, many vendors try to take analytics specific to one LOB, such as Medicare Advantage (MA), and adjust them to make them work for another LOB, such as the Affordable Care Act (ACA).
At Pulse8, we were one of the first to enter the ACA marketplace. ACA members tend to be younger and healthier than members of MA or Medicaid, which makes precision essential when assessing data for this LOB. Our ACA analytics are built to address ACA specific quality initiatives.
Similarly, we understand the challenges of MA. For MA, it is critical to accurately project and track benchmarks and thresholds for STARS measures. The ability to predict outcomes and ensure members are receiving comprehensive care in the MA population is essential for a plan to achieve a 4- or 5-STAR ranking.
Medicaid, on the other hand, is state run. Monitoring each state’s specific requirements is critical for this LOB. Pulse8 has experience staying abreast of each state’s specific regulations and quality program requirements.
In summary, Pulse8 has experience searching for Quality gaps for millions of lives within each of these unique LOBs, allowing us to deliver the highest Quality LOB-specific Quality analyses.
Question 5. Does your Quality solution enable your use of supplemental data to ensure the greatest impact for your Quality programs?
With the future of HEDIS measurement trending toward increased use of electronic data and digital measures, plans must utilize a platform that allows them to leverage supplemental data sources.
Supplemental data fills gaps in claims data, improves the efficiency of data collection, and increases visibility into performance on a prospective basis. Increasing your administrative rates throughout the year allows you a more focused and efficient approach during the retrospective hybrid review.
At Pulse8, our prospective HEDIS strategy includes the use of our product platforms to bi-directionally extract supplemental data from EHRs and push gaps back to the EHR, allowing plans to achieve continuous improvement in both HEDIS and STARS performance.
Prioritize a forward-looking attitude
Question 6. Is your HEDIS measurement and reporting solution (for MY2020 and following) fully certified by the National Committee for Quality Assurance (NCQA)?
Beginning in July 2021, every health plan is required to use a certified HEDIS engine if they want to qualify for HEDIS-based incentives and financial rewards. Certification is a recognition awarded by NCQA to vendors that have passed validation of measures. Although previously home-grown measurement options were acceptable, beginning with Measurement Year 2020 (MY2020) that’s no longer the case.3
Many vendors are currently seeking certification, but Pulse8 is one of the few options fully certified for MY2020.1-3
The importance of a supportive partnership
Whenever you enter a relationship with a new vendor, it’s essential for you to identify your goals so you can make sure your chosen vendor can help you meet those goals. If you’re going to work with a healthcare analytics and technology vendor, your goals may include:
- Gaining information that allows you to analyze member and provider data
- Identifying Quality and care gaps in the data
- Identifying the financial consequences of addressing different gaps, to enable you to prioritize which ones to pursue first
You also need to know that your chosen vendor has the same priorities as you; that is, that they prioritize:
- Accuracy and transparency in their analytics
- Avoiding conflicting financial interests
At Pulse8, we have answered these questions for countless clients. Our broad industry knowledge and experience enables us to work closely with our customers, to ensure that they have everything they need to make informed choices. We invite you to ask these questions of us and any other healthcare analytics and technology vendor you are considering. The answers will help you to identify a partner who shares your unique goals and priorities, who has the expertise to help meet your unique needs.
If you would like to learn more about how Pulse8’s Quality analytics platform, Qualit8, can help you make the most of your Quality programs without wasting time, money, and resources with multiple solutions, register for our upcoming webinar.
- Qualit8 Quality Analytics. Pulse8. Accessed June 30, 2021, https://www.pulse8.com/product/qualit8.
- Illumin8. Pulse8. Accessed June 30, 2021, https://www.pulse8.com/products.html.
- Pulse8’s Qualit8 Solution receives NCQA Measure Certification Program™ for HEDIS® MY 2020 Season. BusinessWire. Updated February 17, 2021. Accessed July 10, 2021, https://www.businesswire.com/news/home/20210217005280/en/Pulse8%E2%80%99s-Qualit8-Solution-receives-NCQA-Measure-Certification-Program%E2%84%A2-for-HEDIS%C2%AE-MY-2020-Season.