Medicare Advantage Star Ratings and other value-based care structures require integration between the quality, pharmacy and finance teams to ensure maximum health plan ROI. Quantify™ is the Adhere™ platform’s real-time analytics engine that integrates health plan quality gaps with financial budgeting processes – measure by measure. Quantify’s advanced analyses stratify and prioritize budgetary investment scenarios across each plan contract quality measure to maximize the aggregate Star Ratings and year-over-year quality improvement (Qi) factor.
Quantify’s data integration leverages machine learning and adaptive data preparation processing to aggregate HEDIS®, pharmacy claims, CAHPS and HOS datasets to provide population cohort analyses. Business analytics provide visualizations that overlay financial costs with benchmarked population predictive models using comparative data sets. Executive dashboards and ad hoc reporting enable health plan executive teams to work collaboratively with greater transparency to achieve greater Star Ratings.
Benefits
Accountable Reporting
360 degree of performance reporting including consumer, provider and measure
Protect Bonus Payments
Stay on target with transparent performance impact and planning
Success Models
Build good, better, best scenarios to determine outcomes impact
Features
Predictive Analytics
Real-time analytics generate predictive Star Ratings performance, including the simulated i-Factor measure boost
Resource Prioritization
Monthly insights into quality measure prioritization for improved overall Star Ratings performance with targeted consumer interventions
Engagement Strategy
Gap closure predictive modeling with consumer and provider-specific engagement analyses
Align Quality and Financial Strategies
Robust financial forecasting scenarios support team collaboration for quality measure intervention tactics
Has Your Health Plan Cracked the CMS Star Ratings Code?
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