Through our outcomes-oriented quality solutions, we serve plans operating in MA, HIX and Medicaid markets to improve quality compliance in a ROI-sensitive manner. The analytics approach includes applying member’s behavioral attributes and socio-economic factors, in addition to standard demographic and clinical factors, to design interventions that yield significant gap closure rates.
There has been an increase in focus on Quality Compliance for health plans due to the launch of several quality bonus programs. While increase in compliance to quality and care guidelines is a certain area of focus for plans, it is becoming a key competitive factor as quality ratings start to drive enrollments. As part of our Quality programs, Advalent integrates superior care coordination models to improve care for members and generate high ROI for health plans. All the analytic insights are translated to identify provider practice patterns and hence tailor alternate payment models that drive long-term efficiencies. Our Quality solutions are EMR ready – with our proprietary EMR-Connectors – to automatically extract the targeted DOS/charts from EMR systems to identify care and quality gaps on a near real-time basis.