Adherence to clinical quality guidelines has moved to the forefront for health plans with the launch of several quality programs, such as HEDIS and STARS, that tie compliance to bonuses. Additionally, it is a key competitive factor as quality ratings have started to drive member enrollments. To stay competitive, plans must establish and maintain a high level of quality compliance, as well as show ongoing improvement to their level of care.
Advalent’s outcomes-oriented clinical quality solutions assist plans operating in Medicare, Medicaid and Exchange markets to improve quality compliance in an ROI-sensitive manner. Our integrated care coordination and 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. The analytic insights can then be used to identify provider practice patterns so that alternate payment models can be implemented to drive long-term efficiencies. Furthermore, Advalent 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.
- Higher quality compliance
- Optimized plan performance
- Improved provider performance
- Increased member satisfaction
- Cost-effective hybrid operations
- Increased care gap closure