7 Ways Health Plans Can Increase Quality Scores

High quality scores not only reflect superior patient care but also attract more members and ensure better reimbursement rates for health plans. Potential members often look at quality scores when selecting a health plan, associating higher scores with better care and service. Existing members are more likely to stay with a health plan that consistently provides high-quality care, reducing churn rates. Here are some strategic steps payors can take to boost quality scores like HEDIS and Medicare Star. 

1. Enhance Member Engagement

Active member engagement is key to improving quality scores. Health plans should:

• Provide Personalized Communication: Tailor communications to member needs and preferences. Use data analytics to understand member behaviors and send targeted reminders for screenings, vaccinations, and regular check-ups.
• Leverage Digital Tools: Utilize apps and online portals to facilitate easy access to health information, appointment scheduling, and telehealth services.
• Encourage Preventive Care: Educate members about the importance of preventive care and offer incentives for completing preventive health measures.

Read more about health plan member engagement solutions. 

2. Focus on Preventive Care and Chronic Disease Management

Preventive care and effective chronic disease management are critical components of high-quality healthcare. Health plans can:

• Implement Comprehensive Care Programs: Develop and support programs focused on chronic disease management, such as diabetes, hypertension, and asthma.
• Coordinate Care: Ensure seamless coordination between primary care physicians, specialists, and other healthcare providers to prevent gaps in care.
• Monitor and Follow-Up: Regularly monitor patients' health status and follow up to ensure they adhere to their treatment plans.

Learn how at-home health testing can meet HEDIS and Star requirements for diabetes management. 

3. Improve Access to Care

Accessibility is a significant factor in quality scores. Health plans should:

• Expand Network Providers: Increase the number of in-network providers to reduce wait times and travel distances for members.
• Offer Telehealth Services: Provide robust telehealth options to ensure members can access care quickly and conveniently.
• Streamline Appointment Scheduling: Simplify the process for scheduling appointments and accessing specialists.

Learn about our Provider of Record API, which helps Ash clients scale fast with radical compliance in all states in which they operate.

4. Enhance Data Analytics and Reporting

Accurate data collection and analysis are vital for tracking performance and identifying areas for improvement. Health plans can:

• Invest in Advanced Analytics: Use advanced data analytics to identify trends, predict outcomes, and tailor interventions.
• Automate Reporting: Implement automated systems for real-time reporting and monitoring of quality metrics.
• Utilize Feedback Loops: Regularly collect and analyze member feedback to identify pain points and improve service delivery.

5. Promote Care Coordination and Integration

Integrated and coordinated care improves patient outcomes and quality scores. Health plans should:

• Foster Collaboration: Encourage collaboration among healthcare providers through shared electronic health records (EHRs) and integrated care teams.
• Implement Case Management: Provide case managers for high-risk members to ensure they receive comprehensive, coordinated care.
• Support Transitional Care: Assist members during transitions between care settings, such as hospital discharge to home care, to prevent readmissions and complications.

6. Ensure Provider Engagement and Training

Engaged and well-trained providers are essential for delivering high-quality care. Health plans can:

• Offer Training Programs: Provide ongoing training and professional development opportunities for healthcare providers to stay updated on best practices.
• Align Incentives: Align provider incentives with quality goals to motivate adherence to high standards of care.
• Facilitate Feedback: Create channels for providers to give feedback and suggest improvements to care processes and protocols.

7. Monitor and Improve Patient Satisfaction

Patient satisfaction directly impacts quality scores. Health plans should:

• Conduct Regular Surveys: Use patient satisfaction surveys to gather insights and identify areas for improvement.
• Address Complaints Promptly: Resolve member complaints quickly and effectively to maintain trust and satisfaction.
• Enhance Customer Service: Invest in high-quality customer service to ensure positive interactions and support for members.

How Ash Wellness supports health plans 

Ash Wellness is dedicated to helping payors leverage at-home health testing to improve member care and outcomes. Our exclusive home testing platform is customizable, API-first, and white-label. We offer services such as kitting, logistics, provider network management, lab contracting, testing, and kit tracking. Ash Wellness keeps patients within the client ecosystem and care continuum through a top-tier, national CLIA/CAP accredited lab network, ensuring redundancy and efficient lab management to save time, money, and resources. For health plans looking to incorporate at-home diagnostic testing, Ash Wellness is the best choice.

Conclusion on how to increase quality scores

Improving quality scores is a multifaceted challenge that requires a strategic approach and commitment to excellence. Health plans can enhance member engagement through focusing on preventive care, improving access to care, leveraging data analytics, promoting care coordination, ensuring provider engagement, and monitoring patient satisfaction. These efforts not only lead to better health outcomes but also strengthen the overall reputation and success of the health plan.