Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Effectiveness Data and Information Set HEDIS

Improving Health Plan Customer Service Through Technology

May 10, 2018 - High quality health plan customer service is critical for payers who want to create meaningful, positive beneficiary interactions. Customer service plays several important roles for health plans.  In addition to the stand-alone goal of leaving members with a satisfactory experience, the quality of customer relations is included in NCQA’s HEDIS measures, one of the most common scoring...


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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 outcomes,...

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.   HPNs are narrow provider networks aimed at...

Top 10 Highest Performing Medicare, Medicaid Health Plans

by Thomas Beaton

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...

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...

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