Finding and eliminating gaps in care continues to be one of the most challenging aspects of the shift to value and better outcomes. As perhaps the most influential payer of all, Medicare is emphasizing shared savings programs to incentivize delivering quality care. Additionally, there has been an industry-wide shift where the focus is no longer on disease management, but rather on population health management as a whole. This makes the opportunity to impact care gaps and quality a much higher priority for at-risk organizations.
Health Plans and Providers are tasked with collaborating on coordinated preventive care and management of chronic conditions through new value-based contract arrangements. Both understand there is a need to secure personnel and data to identify the care gaps that need to be met to increase a patient’s quality of care. This translates to an understanding of the monetary value of quality measures, such as Pay For Performance, STAR Quality Bonus Payments and HEDIS, as well as the penalties for underachievement. The success or failure of member engagement and care coordination services directly affects quality scores and reimbursement. As a result, payers and providers generally have formal quality improvement programs in place. A typical ongoing program for quality improvement includes the following key components:
- Identification of measures and focus areas
- Targeting the outreach to the right population
- Developing multi-channel programs (one size doesn’t fit all)
- Conduct targeted outreach campaigns
- Report, improve, repeat
To satisfy the quality measures put forth by HEDIS, CMS and others requires a much more proactive approach to member engagement. Making use of analytics to identify members who need to close care gaps is certainly one main objective of plans and providers participating in shared savings programs. Once the gaps are identified, a well executed member engagement strategy with the right outreach can make a significant impact.
For a more in-depth case study about how Citra helps quality improvement measures through engagement, click below.