Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Care Quality Measures

Employers are Experimenting with Innovative Health Plan Designs

September 26, 2018 - Just under half of employers participating in a survey from the National Business Group on Health (NBGH) are actively experimenting with innovative health plan designs that aim to foster new approaches to care delivery. NBGH found that employers expect healthcare costs to rise by 6 percent in 2019 without any efforts to reduce costs. However, employers still expect costs to rise by 5...


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NCQA, Health Plans to Measure Patient-Reported Outcomes

by Thomas Beaton

The National Committee for Quality Assurance (NCQA) has selected four health plans to test a new performance standard for collecting patient-reported outcomes measures, or PROMs. NCQA’s Person-Driven Outcome Measurement...

Value-Based Care Slashes Per Member Per Month Costs in Kansas

by Thomas Beaton

BlueCross BlueShield of Kansas has seen significantly lower per member per month costs for beneficiaries participating in value-based care arrangements, including accountable care organizations (ACOs) and patient-centered medical homes...

NCQA Updates, Adds HEDIS Performance Measures for Plan Year 2019

by Thomas Beaton

The National Committee for Quality Assurance (NCQA) has released updates to its HEDIS performance measures for plan year 2019. The refresh includes several new measures to guide population health management initiatives, as well....

Quality Analytics, Risk Adjustment Tools Prep Payers for Success

by Thomas Beaton

Quality analytics and risk adjustment technologies are effective solutions for payers when these tools can structure claims and clinical information into actionable models, identify multiple risk indicators, and foster provider...

Helping Payers Implement Value-Based Hospital Reimbursement

by Thomas Beaton

Hospitals generate some of the largest revenues and create exceptionally high costs for payers, which combine open the possibility for value-based hospital reimbursement programs to control spending.        In March...

Health Plan Data Governance Assists Value-Based Reimbursement

by Thomas Beaton

Health plan data governance plays a key role in overcoming barriers related to industry-wide adoption of value-based reimbursement, according to a two-year study conducted by CAQH CORE.  Health plans are industry leaders who should...

Patient, Provider Engagement Drives High Health Plan Performance

by Thomas Beaton

Health plan performance, and how to improve it, is always an issue at the forefront of payers’ minds.  While payers have engaged in several strategies in the past aimed at improving clinical quality, reducing costs, and boosting...

NCQA Seeks Stakeholder Comments on Updated HEDIS Measures

by Thomas Beaton

NCQA is seeking health plan, provider, and related stakeholder public comments to weigh in on updated HEDIS measures and the implementation of new measures related to chronic disease management. NCQA wants to implement measures related to...

Top 10 Highest Performing Commercial Health Plans

by Thomas Beaton

The top performing commercial health plans in the US for 2017-18 exceeded expectations for customer satisfaction, preventive care, and outcomes of their beneficiaries, according to the National Committee for Quality Assurance (NCQA). NCQA...

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