How One Payer Improved 19 Key HEDIS® Measures in Just 11 Months

Lori Herb, Senior Director, Clinical Outreach and Engagement

Recognizing the need to improve quality reporting, one health plan turned to Geneia. By leveraging Geneia’s advanced analytics, expert population health consultants and innovative clinical services to drive alignment and collaboration with provider partners and employer groups, the health plan successfully – and quickly -- improved key performance measures.

These measures were strategically chosen for their alignment with industry accreditation, CMS Star Ratings (STARS), Quality Rating System (QRS) and the Federal Employee Program (FEP).

In just 11 months:

  • Health plan value-based provider partners markedly outperformed their fee-for-service peers in 19 of 25 tracked measures, notably:
    • Breast cancer screenings
    • Cervical cancer screenings
    • Colorectal cancer screenings
    • Childhood immunization status
    • Comprehensive diabetes care
  • Health plan value-based provider partners significantly reduced high-cost utilization, such as:
    • Ambulatory care
    • Emergency department visits

Bottom Line Results

Changes in the healthcare industry require health plans, providers and employer groups to come together to support member engagement and improved health outcomes. Our client’s collaborative approach resulted in the successful delivery of cost-controlled, quality-enhanced care.

Download Geneia’s new white paper, 10 Proven Ways to Improve HEDIS® Reporting and Quality of Care for Members, to read how the health plan quickly achieved its objectives – and you can too.

This blog was originally posted by Geneia, LLC. See related posts at https://www.geneia.com/blog.

This article was created in collaboration with the sponsoring company and our sales and marketing team. The editorial team does not contribute.