Clinical Quality Measures

CMS Suspends Quality Reporting Measures Amid Pandemic

April 22, 2020 - 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 updates, visit our resource page, updated twice daily by Xtelligent Healthcare Media. The announcement came on April 18, halting all data...

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CMS Releases 2019 Medicare Advantage Health Plan Star Ratings

by Thomas Beaton

CMS has released its 2019 star ratings for Medicare Advantage (MA) health plans, noting that the Medicare Advantage market continues to grow in affordability and access for consumers. CMS estimates...

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...

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...

Payer Input is Key for High Performance Provider Networks

by Thomas Beaton

Payer input is critical for developing high performance networks (HPNs) that are efficient and cost-effective while delivering high quality care, says the Academy of Actuaries in a new report....

How Process, Outcome Measures Contribute to Population Health

by Thomas Beaton

Payers rely on process and outcome quality measures to communicate healthcare performance to new and current beneficiaries. Quality measurements such as HEDIS, CMS Star Ratings, and standardized core...

Payer, Provider Collaboration Required for Accountable Care Success

by Thomas Beaton

The accountable care organization (ACO) movement has gained traction over the last year as payers and providers begin to share the same viewpoints on the benefits of value-based care. Provider...

How to Develop HEDIS Quality Measures for Pediatric Care

by Vera Gruessner

The American Academy of Pediatrics (AAP) announced yesterday on its website that it will be partnering with the National Quality Forum (NQF) to connect quality metrics to the interests of children and...

How Payers Can Improve HEDIS Quality Measure Performance

by Vera Gruessner

HEDIS quality measures have a significant role in the healthcare industry regarding closing gaps in care and decreasing the use of costly acute care through preventive services. By placing a greater focus on value-based care and quality...

Cigna’s Key Principles for Healthcare Quality Measures

by Vera Gruessner

Cigna is one national health insurance company that has moved forward with creating successful healthcare quality measures for their provider networks. The company uses national standards along with...

Humana Standardizes Healthcare Quality Measures for Physicians

by Vera Gruessner

Last week, Humana announced in a company press release the development of a Clinical Quality Metrics Alignment (CQMA) program meant to simplify and regulate healthcare quality measures. The new...

Clinical Data Analytics Key for Value-Based Care Reimbursement

by Vera Gruessner

Many medical facilities have seen how the healthcare industry has been moving away from fee-for-service payment to value-based care reimbursement. Revere Health is one organization that jumped on the...

Quality Metrics Pose Problems for Value-Based Care Reimbursement

by Vera Gruessner

The healthcare industry’s fast pace transition to value-based care reimbursement has led to some major challenges for both providers and payers. Adopting completely new payment contracts...

Top 4 Best Practices for Transitioning to Value-Based Care

by Vera Gruessner

With the healthcare industry continually reforming toward better patient outcomes and reduced medical spending, health insurance companies have been moving away from fee-for-service payment structures...

Misalignment of Healthcare Quality Measures Impacts Payers

by Vera Gruessner

In the healthcare industry’s move toward value-based care reimbursement, public and private payers create healthcare quality measures meant to align with how providers are paid and what type of...

3 Key Strategies for a Successful Payer-Provider Relationship

by Vera Gruessner

What are the key ingredients that health insurance companies need to integrate in order to have a successful payer-provider relationship? There are a number of steps that payers and providers will need...

How Quality Metrics Affect Value-Based Care Reimbursement

by Vera Gruessner

In today’s changing healthcare landscape, public and private health payers are attempting to investigate new payment models in order to reduce the continually rising medical spending. Whether...

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