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.
Issuers and their third-party administrators (TPA) were all working towards meeting the Dec. 19, 2014, deadline for the data production data submission to the Centers for Medicare and Medicaid Services (CMS). On the evening of Dec. 19, 2014, CMS officially notified all issuers that the deadline for the first preliminary run had been extended to Dec. 28, 2014, to ensure that most issuers are able to meet the requirement for the data-submission deadline to the EDGE server.
Proposed Changes to Promote Continued Participation and Growth
On Dec. 1, 2014, the Centers for Medicare and Medicaid (CMS) issued proposed changes to the Medicare Shared Savings Program (MSSP) to promote continued participation and growth. The proposed changes are intended to further support and incentivize ACOs to achieve the triple aim in improving patient satisfaction, quality and reducing the cost of care.
Within the 429-hundred-page document there are numerous proposed changes. Here, we examine three key changes that could impact ACOs regarding payment tracks and beneficiary assignment.
The introduction of the Affordable Care Act’s Health Insurance Marketplace has created a rapidly growing, competitive landscape with diverse audience segments. Member engagement has become a key focus for health plans to increase member interaction, preventive health assessments, and better self-care initiatives.
Member engagement programs can provide enormous benefits to both members and health plans, if executed properly. Members will benefit from increased access to care, enhanced awareness of their health status, and improved care management. Moreover, health plan providers are seeing reduced emergency room visits, a lower rate of unnecessary diagnostic tests and, most importantly, fewer gaps in care and greater risk score accuracy.