WHAT WE DO
Power measurable care improvements with actionable metrics.
Health plans receive updates on their National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS®) scores only once a year, leaving little room for proactive adjustments and forcing retrospective course corrections.
CareMetrix changes the game by enabling health plans to monitor their HEDIS quality metrics on an ongoing basis, identify areas for improvement, and implement highly automated member engagement workflow for gap closure and, most importantly, improve the quality of care members receive!
HEDIS measures are pivotal in shaping key ratings, including:
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Medicare Advantage Star Ratings
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Marketplace health plan ratings for commercial, Medicare, and Medicaid plans
For health plans, these ratings impact:
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Finances - bonus payments and reimbursements
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Enrollment - auto-assignment enrollment and members gravitate toward higher-rated plans
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Reputational Risk - ratings signal quality to stakeholders and consumers
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Regulatory Compliance - underperformance may lead to increased regulatory scrutiny and operational restrictions
CareMetrix STEP: proactive engagement for better results
Our member engagement and analytics platform offers a two-pronged approach to improving your performance:
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Score - Daily quality measure reports
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Target - Dynamic lists for member communications and gap closure
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Engage - Engagement workflows informed by member preferences and configurable workflows
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Perform - Data management features for data quality enhancement, audit compliance, and cost-effective gap closure
Key benefits
The CareMetrix STEP platform is an end-to-end solution that automates screening and intervention workflows for identified care gaps.
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Daily line-of-sight into quality performance
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Identifies gaps in care (e.g. preventative screenings, blood pressure screenings, and immunizations) and trends in quality problem areas
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Aggregates and analyzes gap reports that can be configured to automatically trigger:
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Survey distribution to members with care gaps, such as PHQ-9 depression screening
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Provider notifications about needed care
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Member engagement through analytics and incentives
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Secure cloud environment leaves health plans in control of their members’ data
IMPROVE HEALTH OUTCOMES
Member engagement simplified.
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Automates data collection from multiple sources (claims, EHR, etc.)
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Standardizes the data and then calculates HEDIS quality measures on a near real-time basis
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Creates gaps in care reports sent to providers, care managers, and quality managers
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Triggers automated patient engagement system to encourage members to fill gaps in care and complete needed surveys
STATE OF THE ART TECHNOLOGY
Secure
Siloed and secure API implementation resides on your existing cloud architecture
Outputs
Standardized data ready for HEDIS, FHIR®, and EHR integration
Workflow
Automated member engagement strategies that maximize care gap fulfillment