One of the most critical enterprise capabilities in preparing for the shift to value-based programs and advanced alternative payment arrangements is an infrastructure and technology blueprint and roadmap to support the ever increasing quality measurement load. On average, health plans calculate and report over 320 unique quality metrics to comply with government programs and commercial contracts. Larger ACOs and INDs have a slightly smaller load: 100+ measures – but with MACRA, this will increase!
Agile quality improvement and quality measurement reporting require combining content from clinical, claims, administrative and patient self-reported/ patient monitoring data streams with internal insights and intelligence into a patient-centric repository. A patient-centric repository needs to be a scalable, extensible of the set of services to share data (hDaaS) with internal and external stakeholders. The repository, clinical in nature, is the lynchpin of the new quality scaffolding.
As we see it, there are 5 main advantages of the new quality scaffolding, including:
1. Maximize and leverage existing technology and infrastructure investment
Leverage and extend existing Smart Trading infrastructure
Leverage and extend your data warehouse with an Integrated Patient Repository as the source for information for UM, Authorization and other medical management needs
2. Reduce administrative burden on MM staff
Use the single enterprise member repository as the source for information for UM, authorizations and other medical management needs
Vend updated/normalized data to your care management system and registries – expand content vended to QM/UM over time to increase automation
3. Improve fidelity and content in reporting to employers/groups
Use latest and continuously gathered member clinical data to incorporate population insights to Enable better choice and investments related to health and wellness programs – tailored to specific needs of employees and families
4. Increase efficiency in quality reporting
Use the single enterprise member repository as the source for information for hybrid measures
Vend updated/normalized data to your QM system for updated measure calculations – don’t wait till end of the measure period!
5. Improve QPI* & MM* scalability to support PCMH programs
Maximize the capacity of existing MM and QPI staff by minimizing administrative tasks to support PCMH programs
Enable greater automation in aggregation of data to support quality management and care coordination in PCMH programs
Replicate successful informatics practices across programs