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....
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 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....
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...
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...
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...
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...
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...
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 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...
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...
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...
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...
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...
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...
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...
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...
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...
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...
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,...