Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Quality Measures

Top Health Plans Excel in Preventive Care, Chronic Disease Management

September 24, 2018 - Health plans that offered high-quality preventive care and comprehensive chronic disease management received top marks in the latest health plan rankings from the National Committee on Quality Assurance (NCQA). NCQA ranks health plans in three major performance domains including preventive care, chronic disease management, and consumer satisfaction. Plans earn an overall score as well...


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Payers Play Crucial Role in Healthcare Quality Transparency

by Thomas Beaton

Payers will need to take the lead in being transparent about healthcare quality and costs in order to improve patient safety and reduce unnecessary spending, experts told the Senate HELP Committee. Payers can take a more proactive role in...

Earning Top Medicare Advantage Ratings Requires Data, Ambitious Goals

by Thomas Beaton

Succeeding in the highly competitive Medicare Advantage (MA) market requires more than just a sense that there are financial gains to be had in this growing health insurance segment. Payers that wish to reap some of the many financial...

How Can Accreditation Programs Promote Health Plan Value?

by Thomas Beaton

Health plan accreditation programs can help payers highlight offerings that deliver on key quality, efficiency, and beneficiary satisfaction measures. Many health plans currently participate in the HEDIS performance set and receive...

Payers See Cost, Quality Gains with Value-Based Payment Models

by Thomas Beaton

Payers and providers participating in value-based payment models are seeing reduced costs and improvements in care quality.   Value-based payment, which is expected to account for 59 percent of all healthcare payments by 2020, helps...

Top 10 Highest Performing Medicare Advantage Health Plans

by Thomas Beaton

Medicare Advantage (MA) plans are growing in popularity as an aging consumer population seeks comprehensive coverage for acute and chronic care needs. A competitive, lucrative market for high-performing plans has emerged, giving payers an...

Medicare Advantage Star Ratings Tied to Member Socioeconomic Strata

by Thomas Beaton

Medicare Advantage (MA) health plans with a greater proportion of socioeconomically challenged members are more likely to have lower star ratings, according to new research from Brown University. Insufficient risk adjustment criteria in...

Value-Based Payment Adoption Drives 5.6% Reduction in Care Costs

by Thomas Beaton

Payers that implemented value-based payment models reduced healthcare costs by an average of 5.6 percent, improved provider collaboration, and created more impactful member engagement, according to a new study from Change Healthcare. The...

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...

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