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 HEDIS®, Quality Rating Systems (QRS), Star Ratings, Pharmacy Quality Alliance (PQA) and state-specific quality measures.
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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.
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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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 patented 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 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).