Qualit8

Prioritizing and directing Gap Closure efforts for Star Ratings, QRS, and Medicaid through predictive analytics and Dynamic Intervention Planning

HEDIS®-based quality metrics are progressively driving the accountability and profitability of government programs with payments, penalties, and bonuses that are “graded on a curve” relative to one’s competitors.

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Key features making Qualit8 the most strategic, dynamic, and coordinated solution for closing quality gaps and improving quality scores:

Predictive models to identify all members who might have an open care gap that would warrant inclusion in the denominator of each quality metric, including those tied to chronic conditions not currently coded and at risk for disease progression, and false negatives not yet recognized by care management
Dynamic Intervention Planning that incorporates member and provider behavior
Advanced Analytics for monitoring, measuring, and reporting on each quality metric, and assimilating these data in order to redirect interventions where needed most
Statistical projections and comparison analyses of client data versus benchmarks to master the relative determination models used in grading plans against one another
Pulse8’s Qualit8 dashboard suite will allow QM professionals to identify those providers and members with the greatest opportunity, proactively identify trends in measure performance, with drill-downs at each sequential level (e.g. metric system, measure, health plan, medical group, individual provider, and member level)

A myriad of Quality Improvement initiatives exist, all aimed at improving one’s scores, but far too numerous and costly to blindly pursue. To successfully navigate this maze, today’s health plans need to employ a data-driven triad of gap identification, strategic intervention, and dynamic recalibration. Qualit8 provides the “command center” from which to orchestrate your Quality Management endeavors, using a series of inter-related analytic dashboard suites.

Qualit8 integrates efforts to close Quality gaps with those aimed at Documentation and Coding, to produce a coordinated road map that is more efficient for the plan, less disruptive to providers, and more respectful of the members. We assign confidence levels to the likelihood of closing each gap at the individual provider- and member-level, priority scores to the revenue impact of addressing each quality metric, and grades for both clinical performance and coding efficacy to providers and medical groups – all for the purpose of optimally deploying your finite resources to maximize financial impact and document care quality.

Qualit8 is the Quality Command Center in Pulse8’s ongoing journey to provide risk-bearing entities with the most pragmatic gap closure solution available anywhere.

Calcul8

Risk Adjustment Analytics & Reporting

Qualit8

Quality Analytics

Formul8

Pharmacy Program Management

EMR Analytics & Integration