Advalent Quality360™
Quality Measurement and Improvement Solution

Advalent’s 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 for every member

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

  • Improve both clinical and financial performance

    Provide the right care to all members along while improving overall quality of care, clinical outcomes and payment tied to quality scores.

  • Promote provider awareness and payer-provider collaboration

    Generate sustainable clinical and financial improvements by engaging providers with the right programs (education, gap-closure etc.) at the point-of-care.

  • Track provider quality patterns across all lines of business

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

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

    Depending on member, disease and provider profiles close the care and quality gaps using the most appropriate interventions – Nurse Calls, Care or Disease Management, Case Management, Home Health or Provider Appointments.

Advalent Quality360™ 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

Benefits

GENERATE SUPERIOR ROI FROM YOUR QUALITY IMPROVEMENT PROGRAMS

Ensured high predictive accuracy by deploying hundreds of quality measures and related advanced analytics by applying various advanced statistical methods.

ENABLE INTEGRATED QUALITY, RISK ADJUSTMENT AND POPULATION HEALTH PROGRAMS

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.

DRIVE SUSTAINABLE CLINICAL IMPROVEMENTS

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

DEPLOY THE PROVIDER INCENTIVES/DISINCENTIVES

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

ENHANCE COMPLETE FINANCIAL AND CLINICAL PERFORMANCE

Enhance provider performance by providing targeted recommendations via performance reports to drive continuous clinical and financial improvements.