How Payers Help Tackle Substance Use Disorders, Other Conditions
The National Quality Forum’s (NQF) Opioids and Behavioral Health committee brought together healthcare leaders from across the nation to explore an under-represented subject: strategies around substance use disorders with...NCQA Releases Health Plan Performance Ratings with COVID-19 Data
The National Committee for Quality Assurance (NCQA) has released its first set of Health Plan Ratings since 2019, providing insight into health plan performance during the coronavirus...Essential Home Healthcare Quality Measures for Value-Based Care
As home healthcare becomes more common, payers pursuing value-based care arrangements with home healthcare providers will need to establish strong home healthcare quality measurements. The coronavirus...The Fundamentals of Medicare Advantage Star Rating Methodology
The way to determine the quality of a Medicare Advantage health plan is simple: look at the five-star rating on the Medicare website. However, the Medicare Advantage Star Rating methodology that...NCQA Calls for Digital Quality Measures in Value-Based Care Plans
The National Committee for Quality Assurance (NCQA) released a report with health equity recommendations for HHS and CMS, including enabling a digital quality measure system and strengthening Medicare...How Payers Can Take Action Against Racial Care Disparities
Update 3/10/2021: This article has been updated to accurately reflect Mark Friedberg's argument that care disparities in the payer industry were the result of a lack of equity measures...Benefits of Digital Quality Measures for Payer Quality Reporting
When a major crisis hits, gathering quality measures data can be challenging or nearly impossible with the current strategies. In order for a health plan to be accredited by the National Committee for...Key Quality Measures for 2020, How to Select Measures Effectively
The Core Quality Measure Collaborative (CQMC), a partnership between America’s Health Insurance Plans, CMS, and the National Quality Forum (NQF) that establishes quality measures to promote...12 Leading Medicare Advantage Payers by 2020 CMS Star Ratings
Going into what would be a tumultuous year for Medicare, twelve Medicare Advantage payers proved to be leaders in their field with five-star Medicare Advantage Star Ratings. In a recent post, Matt...Employers Unaware of How to Compare Health Plan Quality Measures
Employers find the health plan selection process cumbersome and are not aware of how to compare health plan quality measures using the National Committee for Quality Assurance (NCQA) tools, two NCQA...Payer Fuses Value-Based Care, Support Payments for Small Practices
Blue Cross Blue Shield of Massachusetts (Blue Cross) announced a new value-based payment model that offers small practices financial support through a global payment, upside risk incentives, and an...5 Ways Payers Can Improve Quality Measures for Chronic Members
Updated 7/7/2020: This article has been updated to reflect that CitiusTech is solely responsible for the “COVID-19 Impact on Quality Management” survey. A previous version associated...Humana Calls for Social Determinants of Health in Risk Adjustment
In a recent joint article with the National Quality Forum (NQF), Humana called for a new risk adjustment model that accounts for both clinical factors and social determinants of health. “We...CMS Suspends Quality Reporting Measures Amid Pandemic
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...How Provider Relationships Shape VBC Pediatric Quality Measures
If value-based care in pediatric healthcare truly is the future of value-based care, payers need to leverage strong provider relationships to establish effective pediatric quality measures in order to...AL Providers, Payer Form Value-Based Medicare Advantage Plan
Huntsville Hospital and University of Alabama Birmingham Health System (UAB) are partnering to create a value-based Medicare Advantage plan through Viva Health. “We are true partners in our...How Medicare Advantage Is Leading Payers to Adopt Value-Based Care
As America strives for positive changes to the healthcare system, it may find the greatest advancements for value-based care in Medicare Advantage plans. Over 90 percent of healthcare payers in a small Health Care Payment...Community Health Workers Fill Gaps in Rural Healthcare
Transportation is one of the biggest challenges to rural healthcare. Often, the most remote areas of the country do not have robust public transportation networks; and for those with access to...Sponsored Article
How Quality Fits into Value-Based Care, Organizational Improvement
Value-based care reimbursement strategies represent a shift in focus from the quantity of health services delivered to the quality of those services. Highlighting the importance of quality is ingrained...Sponsored Article
