The 9th Annual RISE Summit in Nashville, TN, which occurred March 25-27, brought together over 200 of the healthcare industry’s leading organizations. The conference focused on how improvement in risk adjustment accuracy and quality performance delivers measurable results in the healthcare landscape.
As the healthcare industry shifts from a consumption and value based model to one driven by quality, value and efficiency, consumers now have more choices than ever. As a result, health plans are increasingly focused on becoming more consumer-centric, implementing innovative member engagement strategies as a competitive differentiator not only to promote well-being, but to attract new members and retain existing members.
Engaging members is essential from a quality, value and efficiency standpoint. Further, studies show that engagement programs and incentives can greatly improve participation in health promotion programs, while building brand loyalty – a key factor in member retention.
Inovalon’s cloud-based data analytics and data-driven intervention platforms play an integral role in the evolution of the healthcare industry. No other company offers the combination of large proprietary datasets, advanced data integration technologies, sophisticated predictive analytics and deep subject matter expertise. As the industry shifts to value and quality outcome models, the ability to efficiently and rapidly integrate and analyze large sets of data has become increasingly critical for healthcare organizations to be successful. In virtually every stage of the healthcare system– Big Data analytics can provide the clarity needed to achieve meaningful insight and improvement in clinical and quality outcomes, utilization and financial performance across the healthcare landscape.
Successfully engaging providers and their staff can have a dramatic impact on health plan performance. Health plans find that involved providers lead to improved clinical outcomes and quality ratings, member retention, and overall efficiency. Achieving meaningful provider engagement requires alignment between the quality and financial goals of the health plan and the quality and financial goals of the provider practices. The essential elements to provider engagement with the goal to improve quality and disease coding include the following: Increased adoption of gap-closure activities, improved interoperability, and use of data-driven practices.
The beta launch of the Centers for Medicare and Medicaid Services’ (CMS) Quality Rating System (QRS) will begin early 2015 in preparation for a full rollout in January 2016. Although reporting is required for beta testing in 2015, the QHP’s quality ratings are not publicly available until 2016. As such, there are quite a few steps health plans must take in order to prepare for the rollout, which are outlined in detail below.