Improve quality compliance to drive better clinical outcomes

Quality360™ (NCQA-certified) allows payers and risk-bearing providers to measure quality using more than 150 clinical quality measures that span across HEDIS, eCQM and STARS. In addition, the platform deploys predictive analytics to pinpoint and prioritize quality/care gaps and assign the most appropriate member and provider interventions.

  • Understand quality compliance patterns and identify gaps

    Analyze all available administrative and clinical datasets to accurately assess clinical quality compliance and identify care gaps for every member.

  • Drive sustainable clinical improvements

    Significantly improve network efficiencies by leveraging top performers and supporting low-performing providers through varied provider collaboration strategies.

  • Improve financial performance

    Provide members with the right care, improve their clinical outcomes, and ensure you are receiving the appropriate payments tied to quality scores with one easy-to-use tool.

  • Promote provider awareness and payer-provider collaboration

    Generate sustainable clinical and financial improvements by engaging providers with the right programs for their member populations.

  • Deploy provider incentives/disincentives

    Proprietary analytical models enable decision makers to identify suitable value-based reimbursement strategies that improve clinical quality significantly.

  • Track provider quality patterns across all lines of business

    Using all HEDIS, eCQM and STAR measures, readily assess provider compliance to quality measures and identify improvement opportunities.

  • Deploy high-ROI operational activities to close Quality and Care gaps

    Identify and utilize the most appropriate interventions – nurse calls, disease management, case management, home health or provider appointments – to quickly and efficiently close gaps in quality and care.

  • Integrate quality, risk adjustment and population health progams

    Integrate quality/care gaps and potential adverse events (ER utilization, readmissions, preference sensitive treatments etc.) and drive provider engagement to improve plan-level clinical and financial performance.

Key Features:
  • Connect all available data sources (both administrative and clinical) to assess complete clinical state of every member
  • Identify and prioritize care and quality gaps in addition to attributing them to providers for driving quality improvement programs
  • Create actionable list of members and providers to drive care and quality improvements
  • Identify provider contract optimization opportunities to enable value-based reimbursement and deploy the right provider collaboration programs
  • Out-of-the-box provider attribution and provider performance scoring algorithms along with an ability to configure plan-design characteristics