Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Effectiveness Data and Information Set HEDIS

Top 10 Highest Performing Medicare, Medicaid Health Plans

February 1, 2018 - The top-performing Medicare and Medicaid health plans for the 2017-18 plan year earned exceptional quality scores based on the plans’ customer satisfaction, preventive care, and treatment outcomes of beneficiaries, according to the most recent National Committee for Quality Assurance (NCQA) rankings. NCQA determined which plans in the public payer sector performed the best by aggregating...


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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 aggregated...

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 quality measures (CQMs) are some of the tools...

How HEDIS, CMS Star Ratings, CQMs Impact Healthcare Payers

by Thomas Beaton

Quality performance metrics such as HEDIS, CMS Star Ratings, and standardized core quality measures (CQMs) can give consumers an objective indication of healthcare payer quality. Standardized quality measures aggregate how well a payer has performed...

CMS Uses Gender, Race For Quality of Care Medicare Study

by Jesse Migneault

The CMS office of Minority Health released a report with data on the quality of care received by Medicare Advantage (MA) enrollees by gender in four ethnic or racial categories.  The data generated by these reports was not used to evaluate...

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 pediatric care. The National Quality Forum...

How to Reduce Obesity Rates, Increase HEDIS Quality Scores

by Vera Gruessner

When attempting to improve provider performance on HEDIS quality scores, healthcare payers may need to pick and choose the quality measures that could be realistically raised. For example, childhood obesity may be one of the most common health...

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 physician feedback when creating its own healthcare...

4 Key Ways Payers Could Reach HEDIS Score Thresholds

by Vera Gruessner

Health payers looking to increase consumer satisfaction and member retention may need to reach care quality metrics and HEDIS measures. The National Committee for Quality Assurance (NCQA) is responsible for many aspects of HEDIS measures and...

Top 10 Healthcare Insurance Headlines from 2016 Involve Value

by Vera Gruessner

Over the last year, the medical insurance industry has undergone a variety of changes and overcame challenges as the space transitioned to value-based care. Below we outline ten of the most influential healthcare insurance headlines from 2016...

Top 3 Trends Affecting the Health Insurance Market in 2016

by Vera Gruessner

Looking back at 2016, there were a number of different trends that continued to impact the health insurance market. The Triple Aim of Healthcare continues to be a major part of the ongoing reforms and trends throughout the insurance industry...

Health Payer Solutions for Improving HEDIS Quality Scores

by Vera Gruessner

Payers and providers transitioning to value-based care reimbursement need to commit to meeting and improving their HEDIS quality scores. However, the documentation involved in reporting HEDIS quality scores tends to become complex. Johns...

Humana Serves 63% of Members through Value-Based Care Payment

by Vera Gruessner

The future for the health insurance industry likely revolves around value-based care payment, which has grown in use steadily over the last several years. Recent healthcare reforms have centered around tracking the quality of care, reducing spending,...

Humana Spent $93M in Quality Payments for Provider Network

by Vera Gruessner

The national payer Humana announced in a company press release earlier this week that it has reimbursed more than $93.6 million to more than 4,000 provider groups countrywide participating in their Provider Quality Rewards Program. These particular...

3 Key Steps for Health Payers to Meet HEDIS Quality Measures

by Vera Gruessner

Health insurance companies are slowly moving toward adopting alternative payment models based on pay-for-performance metrics. This means more payers and providers are focused on meeting HEDIS quality measures. The scores payers receive on HEDIS...

New England, Great Lakes Perform Best at HEDIS Quality Measures

by Vera Gruessner

More than 90 percent of commercial health insurance companies throughout the country adhere to HEDIS quality measures in order to show consumers and surveillance agencies their overall performance with regard to prevention, treatment, and patient...

Payers Could Boost HEDIS Quality Measures by Exchanging Data

by Vera Gruessner

HEDIS quality measures are managed by the National Committee for Quality Assurance (NCQA), which allows consumers to compare the quality of health plans among more than 90 percent of health payers around the country. HEDIS quality measures require...

Best Practices to Drive HEDIS Success in 2017

by Brian Drozdowicz of Verisk Health

Achieving success requires plans to adhere to annual changes from the National Committee for Quality Assurance (NCQA) related to HEDIS measurement, reporting requirements, and timelines. In addition, health plans can better position themselves...

NCQA Proposes New Changes to HEDIS Quality Measures in 2017

by Vera Gruessner

The National Committee for Quality Assurance (NCQA) is looking to broaden a number of HEDIS quality measures for the 2017 edition, according to a news release from NCQA. These changes include the addition of four new HEDIS quality measures and...

Why HEDIS Quality Measures Matter for Value-Based Care

by Vera Gruessner

The Healthcare Effectiveness Data and Information Set (HEDIS) is used by more than 90 percent of health payers to assess and collect data on the performance of providers. HEDIS consists of a number of different measures on which healthcare providers...

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