Data interoperability and transparency ensures effective collaboration with providers, and quality and value for members. For commercial health plans to succeed, they require quality data processes to drive clinical best practices and evidence-based medicine, efficient care coordination and preventive services, and cost-management principles.
Commercial health plans also face challenges with Healthcare Effectiveness Data and Information Set (HEDIS) reporting to the National Quality Foundation (NQF), including burdensome administrative tasks, inadequate reporting of scores by providers, and low preventive screening rates among provider networks.
HealthEC improves HEDIS reporting in the following ways:
Commercial health plan leaders looking to collaborate with provider networks and develop innovative reimbursement contracts can count on HealthEC for assistance. Our subject matter experts provide advisory services to help commercial health plans negotiate financial risk and quality performance metrics, and ensure that clinical decision support tools are adopted to inform cost-effective service decisions.