Quality Outcomes Are Better When Medicaid MCOs Administer Pharmacy Benefits
- Pharmacy-related quality outcomes were better in states where Medicaid managed care organizations administered health plans’ pharmacy benefits, according to a report from Elevance Health. The Menges Group, a healthcare consulting organization, used the National Committee for Quality Assurance (NCQA) Quality Compass data set, including...
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How Quality Measures, Star Ratings Impact Healthcare Payers
Quality performance metrics such as HEDIS, Medicare Advantage Star Ratings, and standardized core quality measures can give consumers an indication of healthcare payer quality. Standardized quality...How Plans Can Improve Race and Ethnicity Data Collection for HEDIS
One question kept coming up when Keirsha Thompson, manager at National Committee for Quality Assurance (NCQA), and her team talked to payers: How can our health plan improve its performance on race and ethnicity data collection for the...Top 10 Highest Performing Medicare, Medicaid Health Plans
The top-performing Medicare and Medicaid health plans for the 2020-21 plan year earned exceptional quality scores based on the plans’ customer satisfaction, preventive care, and treatment...Sponsored Article
Closing Gaps in Care with Advanced Interoperability Capabilities
For health plans participating in risk-based agreements, gaps in care have serious implications for the health outcomes of members and their ability to attain higher quality scores necessary to receive...Sponsored Article
Improving Member Experience with a Unified Data Platform
The coronavirus pandemic is proving to be a seminal moment for health payers eager to reimagine their role in ensuring that members have access to timely and appropriate care. Doing so requires health...Humana Launches Two More Value-Based Program for Specialty Care
The Louisville-based health payer is looking to build on its success in transitioning providers and members to value-based care with the announcement of two new models and twelve inaugural...CMS Suspends Quality Reporting Measures Amid Pandemic
Amid the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) announced the suspension of data collection and reporting linked to several key quality programs. For more coronavirus...Sponsored Article
Driving Innovation in Provider-Payer Value-Based Care Relationships
Alternative payment models have emerged in recent years as the healthcare industry has shifted its focus from a fee-for-service reimbursement model to value-based care. This transition is commonly...Using Data Analytics to Reach Five-Star Medicare Quality Measures
Over three years ago when Yvonne Krashkevich became director of quality and accreditation at Geisinger Health Plan, the multi-faceted nature of Medicare quality measures was an enigma to the...Sponsored Article
Using Technology to Close Care Gaps, Improve Care Quality and Cost
Research has shown that care gaps can be both harmful and costly when not properly managed. For example, not managing certain chronic diseases (e.g., diabetes) can lead to serious complications and...Sponsored Article
