Quality and quantity have a nuanced relationship in the healthcare system: put simply, payers want to reduce members’ quantity of low-value services while increasing the number of services that produce better quality care. As a result, utilization measures that track the use of high- and low-value care are critical to a value-based structure. The triple aims of value-based…
The nonprofit National Committee for Quality Assurance has revised quality measures for health plans in the Healthcare Effectiveness Data and Information Set (HEDIS) for measurement year 2023. NCQA has added race/ethnicity stratifications and made revisions to acknowledge and affirm member gender identity. Collecting race and ethnicity data is key to improving health disparities, NCQA said….
Download Slides Sometimes you just need a little ‘nudge’. Prospect Medical Systems has initiated a digital outreach strategy to positively impact member satisfaction and improve CAHPS scores. In doing so, they learned first hand how their member communications were operating in departmental silos, with each outreaching to members as needed but detached from the member…
A commercial shared savings program equipped with the right leadership, clinical insights, and comprehensive care strategies can help payers save significantly on healthcare costs and produce exceptional beneficiary outcomes. In order to achieve these results, Blue Cross Blue Shield of Arizona (BCBSAZ) has developed a shared savings program with ACO Partner, a Change Healthcare company….