Mastering excellence: A guide to effectively benchmarking your healthcare quality metrics with monthly benchmarking data

Over $12 billion in performance incentives are offered yearly in the U.S. to health plans with top-quality scores. However, these scores are a constantly evolving target, influenced by the industry’s annual performance. This dynamic often leads to health plans misdirecting their efforts, as benchmarks shift in unexpected ways. Consequently, significant investments may yield minimal or no enhancement in healthcare quality metrics, and sometimes, scores may even decline.

The importance of healthcare quality metrics

Traditionally, health plans have only had access to benchmarks that are typically two years old to try and understand how their plan’s performance compares to the market on key performance indicators.

Health plans need to have a sense of how they’re performing during the current measurement year to try to improve measure ratings for things like annual screenings, immunizations, and chronic condition management. Using year-old data can only be so helpful when you’re trying to effect immediate change in this year’s performance.

Inovalon’s Converged Analytics Benchmarking is a pivotal tool in understanding HEDIS® measure performance. It allows health plans to evaluate healthcare services and outcomes against data that enables them to gauge their performance and identify areas for improvement.

The value of timely quality reporting

Monthly benchmark reporting allows health plans to manage and track goals, outreach, and intervention programs month over month. Cut points delivered every month enables health plans to ensure measures are on track. Plus, monthly reporting is unmatched compared to year-old reporting from the National Committee for Quality Assurance and the Centers for Medicare & Medicaid Services benchmarking data that is up to two years old.

For example, a health plan may be interested in tracking the impacts of the change to the Colorectal Cancer Screening (COL) measure due to optional exclusions being made a required exclusion. With Converged Analytics Benchmarking, the health plan can realize they are falling below the 90% percentile benchmark somewhat due to the measure change as well as suspecting their outreach plan has not been as effective and that it could potentially impact their star rating.

Within that same month, they can build and deploy a program to engage members for screenings. The health plan may deploy this program and see that their own screening rates for COL have improved drastically compared to their past performance. So, they are in fact positively impacting screening numbers. We know that’s not enough. The trick is to understand how their performance compares to other health plans.

Now with their finger on the pulse of their COL measure, the health plan can monitor performance throughout the new program. They can use the monthly benchmarking data to determine if their outreach program is positively impacting screening numbers or if more adjustments need to be made to get their COL measure numbers up.

Leveraging readily available data for quality improvement

Having monthly benchmarking data readily available empowers plans to manage their quality performance throughout the year as opposed to making changes at one time of the year and wondering how they will impact members and the reporting throughout the year.

A guide to seamless benchmarking

By using monthly predictive and comparative analytics, never before available in the quality market, health plans can leverage benchmarks to understand where they need to go and how to get there on various measures.

Here are three steps health plans can take to improve monthly benchmarking.

1. Run the measures

Understand and analyze industry trends to decide which measures need a closer look. Consider how to follow data around noteworthy updates to measures like the Colorectal Cancer Screening measure (COL), which measures the percentage of members 45-75 years old who had appropriate screening for colorectal cancer and was recently revised to remove optional exclusions in the measure specifications.

2. Identify the outliers

After identifying the measures that need action and attention, decide what comes next:

• Is your health plan behind the national average? What percentile do they pull between?
• Do you need to remedy your outreach or intervention plans to meet the national average?
• If you are leading the nation or above the curve, consider taking your foot off the gas with outreach for that measure and diverting it to programs that are falling behind.

3. Create an action plan

Empowered with actionable data, health plans can create a well-informed action plan. Health plans can then decide what actions are needed depending on measure trends.

Build a tailored playbook

Having access to recent state and national benchmarks each month gives health plans the power to build and execute a quality playbook that is well-informed, flexible, and able to adjust to how other health plans are doing on the same measures.

Eliminate the guesswork

With prospective national and state benchmarks, delivered monthly via cloud-based software, health plans can transform their approach to HEDIS measures and Star Ratings performance.

Learn more about Converged Analytics Benchmarking or schedule a demo.

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HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA). 

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