Quality360: Tool to optimize Quality Improvement for Value-Based Organizations with real-time processing

Clair360 is an NCQA certified quality reporting and submission solution for HEDIS healthcare quality measures. It plays a significant role in assessing and improving the quality of care provided by healthcare organizations

HEDIS (Healthcare Effectiveness Data and Information Set)

HEDIS measures cover various aspects of healthcare, including preventive care, chronic disease management, Behavioral health, and patient experience. By using standardized metrics, HEDIS enables comparisons across different healthcare organizations and helps identify areas for improvement. It allows healthcare stakeholders to assess and benchmark the quality of care, track performance over time, and drive quality improvement initiatives. Measures include immunization rates, cancer screenings, diabetes care, and adherence to medication guidelines, among others.

AMP (Adherence to Medications for Chronic Conditions Program):

The AMP program is an analytics measure that focuses specifically on medication adherence for chronic conditions. It aims to assess the extent to which patients are taking prescribed medications as recommended. Medication non-adherence is a common problem that can lead to poor health outcomes and increased healthcare costs.

AMP utilizes claims data and pharmacy records to calculate adherence rates for specific chronic conditions such as hypertension, diabetes, and asthma. By identifying patients who are not adherent to their medications, healthcare organizations can intervene and provide targeted interventions to improve adherence rates. This can result in better disease management, reduced hospitalizations, and improved patient outcomes.

PQA (Pharmacy Quality Alliance):

PQA measures cover a wide range of medication-related areas, including medication adherence, appropriate medication use, and medication safety. By analysing PQA measures, healthcare organizations can identify gaps in medication management, implement targeted interventions, and optimize medication use to enhance patient safety and overall healthcare quality.

By utilizing Quality360 analytics measures, healthcare stakeholders can work towards providing high-quality care, improving patient safety, and driving continuous quality improvement efforts

Frequently Asked Questions

HEDIS stands for Healthcare Effectiveness Data and Information Set. It is a set of performance measures used to assess the quality of healthcare services provided by health plans and healthcare organizations. HEDIS measures cover a wide range of areas, including preventive care, chronic disease management, behavioral health, and patient experience.

HEDIS measures are used by health plans, employers, and regulatory bodies to evaluate and compare the performance of healthcare organizations. These measures provide standardized data on various aspects of care, allowing for benchmarking, identification of areas for improvement, and monitoring of quality over time.

HEDIS measures cover different dimensions of healthcare quality. Some examples include:

  1. Breast cancer screening: This measure assesses the percentage of eligible women who receive appropriate breast cancer screenings, such as mammograms.
  2. Childhood immunization status: This measure evaluates the percentage of children who receive recommended vaccinations within the appropriate age ranges.
  3. Diabetes care: This measure examines the management of diabetes by assessing various indicators, such as HbA1c testing, eye exams, and kidney disease monitoring.
  4. Antidepressant medication management: This measure assesses the follow-up care provided to patients diagnosed with depression, including medication management and coordination with other healthcare providers.

HEDIS measures serve as a framework for quality improvement efforts. By measuring and comparing performance across different organizations, healthcare providers can identify areas where they are excelling and areas that need improvement. These measures provide valuable data and insights that can drive evidence-based interventions, process improvements, and ultimately enhance the quality of care provided to patients.

HEDIS measures are not mandatory, but they are widely used and recognized as a standard for measuring healthcare quality. Health plans and healthcare organizations voluntarily report their performance on HEDIS measures to demonstrate their commitment to quality improvement and to meet the requirements of accrediting bodies and regulatory agencies.

Organizations can improve their performance on HEDIS measures by implementing evidence-based practices, care protocols, and quality improvement initiatives. This may involve enhancing preventive care services, implementing care coordination processes, optimizing electronic health record systems, and promoting patient engagement and education. Analyzing performance data, identifying gaps, and implementing targeted interventions are key steps in improving HEDIS scores.