Unlocking Better Outcomes With AHRQ Quality Indicators in VBC Programs

Value-based care (VBC) is no longer a primary-care-only strategy. As health plans broaden their models, they’re increasingly tying incentives to performance across entire provider ecosystems, including hospitals, ambulatory facilities, and multispecialty groups.   

As VBC models mature, the industry has recognized that primary care interventions alone cannot meaningfully bend the cost curve or sustain better outcomes. Many of the biggest drivers of avoidable costs and patient harm occur at the facility level: surgical complications, preventable infections, post-acute variation, and more.  

 Yet health plans have historically had little ability to connect these outcomes to value-based payment design. Agency for Healthcare Research and Quality (AHRQ) quality indicators change that. 

AHRQ quality indicators: A standardized foundation for safety and quality 

AHRQ quality indicators are evidence-based, publicly recognized measures designed to evaluate hospital-level outcomes using readily available administrative data. They include metrics across:  

• Patient Safety Indicators (PSIs): preventable complications such as sepsis or pressure injuries 
• Inpatient Quality Indicators (IQIs): mortality and volume indicators  
• Prevention Quality Indicators (PQIs): avoidable hospitalizations related to chronic disease management  

These measures were created to bring consistency to quality and safety evaluation — and now, they offer health plans a powerful framework for assessing facility performance within VBC contracts.

The intersection of patient safety and value in healthcare 

The conversation around “value” in healthcare has increasingly merged with the conversation around “safety.” High-value care is safe care, care that minimizes preventable harm, reduces waste, and improves outcomes per dollar spent.  

 Yet implementing safer, more efficient care is increasingly challenging. Clinicians face: 

• Rising care complexity  
• Limited time and resources  
• Expanding safety checklists and documentation requirements  
• High patient-to-staff ratios  

Research continues to show that improving safety requires practical, actionable tools, not more burdensome processes. Standardized performance data, like AHRQ quality indicators, offers a meaningful way to prioritize interventions and align incentives around what actually improves outcomes. 

Introducing AHRQ quality indicators in Converged Provider Enablement 

The latest enhancement to Inovalon’s Converged Provider Enablement^TM sheds some light on what is traditionally a blind spot for health plans: insight into facility-level performance.  

Health plans can now track facility-level value-based care performance using a subset of AHRQ quality indicators — a critical advancement that brings consistent, standardized clinical quality measurement to the facilities that drive a significant portion of costs, complications, and member outcomes. 

This enhancement gives plans the visibility they’ve long needed to make smarter contracting decisions, drive stronger provider engagement, and hold more of their network accountable for delivering safe, high-quality, value-based care. 

With this latest release, Inovalon brings AHRQ facility-level performance tracking directly into Converged Provider Enablement, empowering health plans to:  

• Move beyond primary-care-only measurement and incorporate hospital performance into VBC programs 
• Understand which facilities deliver safe, cost-conscious, high-quality care and which introduce risk 
• Identify performance variation across hospitals, health systems, independent physician associations (IPAs), accountable care organizations (ACOs), or large multispecialty networks  
• Use actionable benchmarks to focus on the highest-impact opportunities for improvement
• Track preventable complications and high-risk events using standardized, evidence-based measures  
• Ground VBC decisions in metrics that correlate directly with patient harm and cost 
• Integrate facility performance into provider engagement strategies and scorecards  
• Incentivize improvement and elevate the quality of your network

This capability enhances how Converged Provider Enablement supports plans and providers in working from a shared data foundation to deliver better outcomes and stronger value. 

Broader accountability, better outcomes, stronger value

The industry’s shift to value-based care demands tools that reach across the entire care continuum. AHRQ quality indicators serve as a bridge linking safety, quality, and cost outcomes in a single, standardized framework.  

By embedding these measures into Converged Provider Enablement, Inovalon is helping health plans to:  

• Elevate accountability beyond primary care  
• Strengthen provider partnerships  
• Improve member outcomes  
• Reduce preventable harm  
• Optimize financial performance  

Most importantly, plans gain the visibility needed to reward providers who deliver true value and help others close the gap.

See Converged Provider Enablement in action. 

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