Joshua D. Sclar, MD, MPH, Chief Medical Officer, BioIQ

I recently presented with our partners from Anthem at the 2019 Star Ratings & Quality Management Forum in San Diego. It’s a great conference that brings together some of the nation’s top leaders in the Medicare Advantage quality space. This year’s conference focused on the critical intersection of member experience and quality of care. There is a growing recognition that a person’s care experience is not only linked to quality scores and reimbursement, but also to driving the kind of utilization needed to reduce cost and improve outcomes.

At the conference, several thought leaders in the area of star ratings offered their unique perspectives on member experience in the quality space. These included Jessica Assefa, Senior Director of Star Ratings for Gorman Health Group, John Zweifler, Medical Director at Adventist Health and author of Tipping Healthcare in the Right Direction, and my co-presenter Stuart Rosenblum, Director of Strategic Alliances for Anthem, Inc. Here are some highlights from the discussion around creating the kind of member experience that leads to better outcomes for members and improved quality ratings and reimbursement for payers.

  1. While there are many issues related to improving quality of care and member experience that health plans are working to address, one that is central to both constructs is the notion of reaching vulnerable populations. As the race to the top picks up speed, more and more health plans have addressed administrative challenges, data quality issues, and other operational hurdles that undermine quality measurement. Similarly, high-performing plans have re-shaped their networks, provider engagement efforts, and product design with an eye toward star measure performance. While work in those areas will never be finished, plans are increasingly turning their attention to reaching members the healthcare system has somehow left behind.
  2. Social determinants of health (SDOH), as well as the health disparities that result from them, remain front and center in the conversation as plans recognize the importance of reaching vulnerable populations. Quality departments are increasingly interested in finding ways to design quality improvement programs with reducing health disparities in mind, which means having access to data on the convergence of social determinants and care gaps — and having the tools to address that convergence.
  3. Many aspects of the care experience can exacerbate the challenges vulnerable populations face. Care delivery models that depend exclusively on access to providers or expect members to participate on terms that primarily suit their health plan result in poor utilization and engagement. Making matters worse, many quality measures are tied to delivery of clinical preventive services, which usually means less motivation to seek care in the first place (compare the desire of a member with a gout attack to seek care with that of a member who is overdue for their screening colonoscopy). Reaching people where they live their lives with a care experience that works for them is especially important when reaching out to vulnerable populations in an attempt to boost quality scores.
  4. There is growing interest in programs like those offered by BioIQ. Our programs leverage consumer-friendly delivery models, behavioral science principles, a wealth of non-clinical data now available on American consumers and can address the access challenges vulnerable populations often face. The result is the ability to connect previously unengaged members with a more compelling experience of care that works for them.
  5. Thoughtful use of strategic partners will be increasingly important for health plans as the number of compelling delivery models and options for reaching members increases. Retail healthcare services and ride share companies are already having an impact in the space, a trend that will only accelerate. At a time when most plans are weary of the number of vendors they already have, this underscores the importance of selecting partners who can integrate and consolidate a rapidly evolving ecosystem of care solutions.

The intersection of member experience and quality of care will only continue to grow. Convenient, member-centric care that addresses social determinants is critical to driving good utilization of preventive services. Care delivery models that put the member first don’t just boost quality scores, they can reduce health disparities and improves outcomes. The BioIQ team believes that in partnership with health plans, we can build programs that will enhance the member experience, drive better outcomes and improve quality of life for all members.

To hear more from BioIQ’s Chief Medical Officer Joshua Sclar, check out the recording of his recent webinar, Clinical Adherence Starts With Member Experience. 

Joshua D. Sclar, MD, MPH

BioIQ’s Chief Medical Officer

Joshua D. Sclar is board-certified in preventive medicine and public health and his career has spanned clinical practice, health services research, public health instruction, and healthcare entrepreneurship.

Dr. Sclar received his medical degree from the State University of New York and completed residency training at Johns Hopkins. He earned a master’s degree in public health as a BJC Healthcare Scholar at Washington University in St. Louis and holds a bachelor’s degree from the University of Miami.

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