Today’s healthcare climate requires health plans to offer high-quality care to their members and to be held publicly accountable for it. Two key measures assess health plan quality: CMS star ratings, which the Centers for Medicare and Medicaid Services (CMS) uses to rate Medicare Advantage plans, and the Healthcare Effectiveness Data and Information Set (HEDIS), a tool published by the National Committee for Quality Assurance (NCQA), which more than 90 percent of health plans use to measure performance.
These measures, and the financial incentives and penalties associated with them, are leading health plans to reexamine standard operating procedures to more effectively close care gaps and provide high-quality services – and for good reason. Health plans that focus on improving quality, and by extension HEDIS and CMS star ratings, stand to gain significant financial benefits.
Conversely, poor star ratings translate to both a loss of reimbursement and financial penalties assessed by CMS. Consistently poor performance can lead CMS to revoke a health plan’s privilege to offer Medicare programs. Because ratings are publicly available and commonly used by individuals who are shopping for a health plan, poor ratings also contribute to a negative public image that can affect revenue.
BioIQ’s newest whitepaper highlights three strategies to help health plans successfully navigate the shift to a healthcare reimbursement model that is increasingly focused on quality.
Create an Organizational Culture of Quality
A quality-based model requires health plans to be accountable for the health of their member populations, and many HEDIS measures are designed to urge health plans to focus on prevention and early detection of chronic disease. To improve quality, health plans must focus on maintaining the health of their populations, in addition to effectively treating those with acute or chronic conditions.
Focus on Disadvantaged Populations
CMS has proposed changes to the Medicare Advantage risk adjustment model that could take population characteristics, such as dual eligibility for Medicare and Medicaid, into account. Regardless of how the risk adjustment model changes, focusing quality improvement initiative on lower income segments can help health plans address significant gaps in care and improve star ratings.
Focus on Improving Performance for Specific Measures
The changes that the Affordable Care Act has made to reimbursement models has encouraged health plans to be honest about their shortcomings and to work rapidly to address them. Plans that allocate resources to measures with the highest potential for improving overall quality ratings can see significant gains in a short amount of time.
How BioIQ Can Help
The BioIQ platform can help health plans close care gaps, increase member engagement and improve quality ratings. BioIQ’s platform for population health measurement provides health plans a simple way to configure screening programs for target segments of their member populations. Health plans can target specific care gaps by configuring screening programs for specific segments of their member populations and providing convenient screening options that ensure high participation rates, such as at-home test kits, screening events or home health visits. BioIQ offers tests that target several specific HEDIS and CMS star rating measures.
By launching a program with BioIQ, health plans can both close care gaps for key star ratings measures and gather data about the health of their member populations to help inform future initiatives.
To learn more, read the free whitepaper.