Quality Measures

Large Employers Focused on Quality and Variety for Open Enrollment

by Kelsey Waddill

Large employers are focused on quality improvement and expanding employees’ health benefit options this open enrollment season, a survey from the National Business Group on Health...

Using Data Analytics to Reach Five-Star Medicare Quality Measures

by Kelsey Waddill

Over three years ago when Yvonne Krashkevich became director of quality and accreditation at Geisinger Health Plan, the multi-faceted nature of Medicare quality measures was an enigma to the...

CMS Adds Star Ratings System to Show Plan Quality on ACA Exchanges

by Kelsey Waddill

Plans on the federal health insurance exchange will publicly display quality ratings on a five-star system in plan year (PY) 2020, CMS announced. The quality ratings will be available for the 2020 open...

What the Healthcare Price Transparency Order Means for Payers

by Kelsey Waddill

President Trump’s regulation requires healthcare price transparency on treatment costs and price negotiations, the White House announced in a press release on Monday “To make fully...

MedPAC Seeks Changes to Medicare Advantage, Star Ratings Metrics

by Kelsey Waddill

In the Medicare Payment Advisory Commission’s (MedPAC) annual June report to Congress, the commission designed the Medicare Advantage value incentive program (MA-VIP), a new set of quality...

Employers are Experimenting with Innovative Health Plan Designs

by Thomas Beaton

Just under half of employers participating in a survey from the National Business Group on Health (NBGH) are actively experimenting with innovative health plan designs that aim to foster new approaches...

NCQA, Health Plans to Measure Patient-Reported Outcomes

by Thomas Beaton

The National Committee for Quality Assurance (NCQA) has selected four health plans to test a new performance standard for collecting patient-reported outcomes measures, or PROMs. NCQA’s...

Top Health Plans Excel in Preventive Care, Chronic Disease Management

by Thomas Beaton

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...

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...

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...

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...

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...

Value-Based Care Slashes Per Member Per Month Costs in Kansas

by Thomas Beaton

BlueCross BlueShield of Kansas has seen significantly lower per member per month costs for beneficiaries participating in value-based care arrangements, including accountable care organizations (ACOs)...

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...

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...

NCQA Updates, Adds HEDIS Performance Measures for Plan Year 2019

by Thomas Beaton

The National Committee for Quality Assurance (NCQA) has released updates to its HEDIS performance measures for plan year 2019. The refresh includes several new measures to guide population health...

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...

Quality Analytics, Risk Adjustment Tools Prep Payers for Success

by Thomas Beaton

Quality analytics and risk adjustment technologies are effective solutions for payers when these tools can structure claims and clinical information into actionable models, identify multiple risk...

Helping Payers Implement Value-Based Hospital Reimbursement

by Thomas Beaton

Hospitals generate some of the largest revenues and create exceptionally high costs for payers, which combine open the possibility for value-based hospital reimbursement programs to control...

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