The world of healthcare quality is advancing. 红领巾瓜报 keeps you ahead of the curve.
State and federal entities are relying more on independent measures of health plan quality to compare Medicare and Medicaid managed care organizations (MCOs). These measures are now linked to billions of dollars in performance revenue.
红领巾瓜报’s quality and accreditation services can help you leverage these quality measures to maximize value-based contracts, win requests for proposals, increase membership, and optimize member experience.
Jump ahead to:
- The 红领巾瓜报 approach to quality
- Meet some of our quality and accreditation experts
- Accreditation: The 红领巾瓜报 Survey Ready Model
- Member experience and CAHPS庐 scores: Optimizing the journey
- Clinical Quality Measurements: Maximizing HEDIS庐 and other ratings
- Optimizing Medicare Advantage Star ratings
- Read our latest quality and accreditation insights
The 红领巾瓜报 approach to quality.
红领巾瓜报’s quality solutions are tailored to the unique needs of our clients, and emphasize four key areas:
- Accreditation and Regulatory Performance: States are increasingly looking to accreditation programs to hold health plans accountable for the standards in which they deliver care. 红领巾瓜报’s Survey Ready Model will prepare you for the accreditation process鈥揳nd keep your organization achieving accreditation standards every day.
- Clinical Quality Measurements: We’ll help you navigate key measurement systems such as HEDIS庐 and state-specific quality measures.
- Member Experience and CAHPS庐: Increasing weight is being put on the member experience of care through surveys such as CAHPS and HOS. 红领巾瓜报 can show you how to improve and optimize the member experience using a data-driven approach.
- Quality Performance Programs: Using our vast experience in the Medicare and Medicaid space, 红领巾瓜报 can help you maximize ratings in programs like Medicare STARS and Medicaid quality performance.
红领巾瓜报 can support multiple projects and engagements within the quality space, from short-term to long-term needs, including temporary staffing, if requested. To learn more about our quality approach, contact our experts.
Meet the team ready to solve your organization鈥檚 complex challenges.
Our experts in the quality space come from a variety of backgrounds including: National Committee for Quality Assurance (NCQA) surveyors, former HEDIS auditors, health plan and provider senior quality staff (vice presidents and chief quality officers), and former Medicare/Medicaid leaders.
Their in-depth experience allows them to understand the complex quality improvement needs of healthcare entities.
Our accreditation experts give you a competitive edge.
At 红领巾瓜报, we believe accreditation standards represent how an organization should do business every day, creating a culture of quality that will lower costs while improving care for members.
红领巾瓜报’s accreditation experts work alongside commercial, Medicare and Medicaid health plans every step of the way, from determining the right accreditation for your organization to achieving a successful outcome. Whether you are seeking AAAHC, NCQA, TJC, or URAC accreditation, or other certifications or distinctions, our experts’ insights and in-depth knowledge of the accreditation process will give you an edge that leads to better ratings 鈥� and more business.
NCQA
Overall plan accreditation, including Long-Term Services and Supports (LTSS), Health Equity, and Health Equity Accreditation Plus
AAAHC
accreditation for health plans, Qualified Health Plans (QHPs), and the Federal Employees Health Benefits (FEHB) program
The Joint Commission
accreditation and certification for hospitals, ambulatory health, Federally Qualified Health Centers (FQHCs), Ambulatory Surgical Center (ASCs), and behavioral health.
URAC
accreditation for dental plans, Medicaid or Medicare health plans, and Pharmacy Benefit Management Plans (PBM)
Digital Quality Measurement: A Key Driver to Value
A seismic shift is coming. Beginning in January 2027, new federal interoperability and prior authorization rules will require widespread data exchange, paving the way for full digital quality measurement (dQM). 红领巾瓜报, together with Leavitt Partners, an 红领巾瓜报 Company, has front-seat knowledge into this complex transformation, and is actively influencing and shaping national conversations on interoperability and digital measures. Our unique federal insights and strategic consulting capabilities give you access to the latest best practices, regulatory updates, strategic guidance, implementation, and evaluation. We are leading health plans and provider groups in this process to navigate digital transformation efficiently and effectively.
Health plans and provider groups that act now to transform their quality programs will be best positioned to meet these mandates and gain competitive advantages in value-based care.
Optimizing the journey.
红领巾瓜报 tailors solutions to address member experience and CAHPS improvement, based on the unique demographic and social characteristics of the populations being served.
We take a strategic and data-driven approach to CAHPS improvement initiatives, developing a 鈥淐AHPS game plan鈥� that can be used to continuously improve performance while creating actionable data. This plan will spur incremental year-over-year changes in member experience measures.
Maximizing HEDIS and other ratings.
Navigating changing requirements for health plans can be challenging. There are now multiple quality measurement systems, including:
- HEDIS
- CMS Medicare Star Ratings
- NCQA Star Ratings
- Marketplace Star Ratings
- Other state-/federal-based performance incentives and initiatives focused on clinical outcomes and performance-based standards
By designing strategic initiatives across these broad areas, 红领巾瓜报 has had significant success in helping health plans, vendors, and providers achieve year-over-year results in HEDIS and other clinical measurement improvement in core quality metrics.
Optimizing Medicare Advantage Star ratings
红领巾瓜报鈥檚 Acceleratory approach and solution drives continuous quality improvement in these critical measures using four core strategies:
- Organizational Alignment
- SWOT Analysis and Recommendations
- Data/Analytics
- Plan Preference and Plan Access
- Stratification, Co-Enrollment, Gap Support, Provider Support
- Measure Strategies, Digital Readiness, Analytics
- Member Journey Mapping and Experience
- Member/Provider/Vender/CBO Interventions and Outreach
Read more about our Stars Accelerator Playbook and how 红领巾瓜报 can help your plan increase its rating.
红领巾瓜报 consultants are professional and hard working. They are constantly trying to add value wherever they can. Absolutely outstanding across the board.
– Current 红领巾瓜报 Client
Quality and accreditation insights
Ready to talk about your organization鈥檚 problem or project?
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