Clinical Quality and Stars
Enhancing Quality Initiatives
In response to Health Reform-driven changes, health plans are developing new approaches to improve quality, track and report important dimensions of cost and service, and document member disease burden. Optum has a comprehensive portfolio of consulting, software and services that deliver a comprehensive approach to improve and measure quality, providing a strategic approach that addresses all areas of performance that impact a plan’s success under the Five-Star Quality Rating System and drive HEDIS reporting efficiency and compliance.
Boost Star Ratings
The Optum™ Stars Performance Improvement Solution consists of consulting, products, and services that together provide a comprehensive approach to Star ratings improvements. Medicare Advantage Plans understand the strategic and financial importance of Stars, but significant complexity and evolving measurement have hindered their efforts to improve scores. By adopting a strategic approach that addresses all the areas of performance that impact star ratings, plans can achieve success in their star ratings initiatives.
The Stars Performance Improvement Solution combines the unmatched expertise of OptumInsight’s consulting team, proven tools and analytics, and products and services to provide the right solution for each client. Optum partners with Medicare Advantage plans to help advance their Star ratings, achieve better health outcomes, and reduce health care costs.
Improve HEDIS Performance
The Healthcare Effectiveness Data and Information Set (HEDIS®) is an industry-wide performance measurement standard by which health plan performance can be compared effectively and uniformly – also providing a way for health plans to track year-to-year performance.
Optum delivers a unique combination of expert consulting, comprehensive services, and leading technologies and reporting tools that provide health plans with data optimization for performance assessment and regulatory compliance reporting using industry standard metrics.
Optum takes a hands-on approach to HEDIS® reporting and consulting services, providing end-to-end support to help health plans optimize their HEDIS rate performance and achieve their Star, accreditation, and pay-for-performance goals. From our cloud-based HEDIS reporting system to medical record review support, audit management, and performance assessment, Optum is committed to helping clients maximize data and processes to increase HEDIS scores – and bottom line performance.
Resources:
Provider and Member Engagement
Direct outreach to providers and to members makes a real impact on achieving goals for evidence-based care, chronic condition management, and key preventative steps. Optum provides comprehensive solutions for your provider and member engagement programs.
Select a solution
Data and Reporting
Real-time reporting and analytics are critical to your ability to evaluate the impact of Stars measure improvement initiatives. The Optum Stars Management Platform provides the information you need to manage your Stars improvement programs.
Select a solution
Medication Adherence
Medication non-adherence represents the leading cause of morbidity, mortality, and health care cost. Optum medication adherence solutions will help Medicare Advantage plans improve on these key triple-weighted Stars measures.
Select a solution