View Post

NCQA Finalizes HEDIS® Telehealth Framework, Goals and Resources

In Affinite Quality, Covid-19, HEDIS & Quality Management by Marketing

As I noted in a previous blog post, NCQA has acted swiftly to adjust HEDIS® requirements to reflect the treatment and outreach challenges presented by COVID-10. Striving to limit healthcare professionals’ exposure to the virus, the new guidelines for outpatient care through video and telephone calls and readings from in-home monitors. Self-isolation recommendations and many patients’ reluctance to travel for …

View Post

Tackling the challenges of bringing risk adjustment in-house

In Risk Adjustment by Marketing

Challenge #3: Execution This is the third in our multi-part series on how health plans can overcome barriers to and reap the rewards of in-house risk adjustment. Part 1 covered process complexity; Part 2 looked at infrastructure. Health plans often focus a majority of their risk adjustment resources on prospective and retrospective services designed to maximise HCC capture. The foundation …

View Post

NCQA Alters Telehealth Standards in Wake of COVID-19

In Covid-19, HEDIS & Quality Management by Marketing

The complications in care delivery brought about by COVID-19 has prompted NCQA to adopt significant changes to more than three dozen of its widely used HEDIS® measures governing telehealth. In a previous post, we discussed how with the right data tools Quality and Care Management teams can prioritize members with chronic diseases who would benefit from treatment and outreach provided …

View Post

Tackling the challenges of bringing risk adjustment in-house

In Risk Adjustment by Marketing

Challenge #2: Infrastructure This is the second in our multi-part series on how health plans can overcome barriers to and reap the rewards of in-house risk adjustment. Click here to read Part 1, dealing with process complexity. Performing risk adjustment operations in-house is an infrastructure-heavy proposition. It requires teams of analysts, coders and their managers, and provider outreach staff. Beyond …

View Post

COVID-19’s Emergence in Infants – Impact on Care Management

In Care Coordination, Care Management, Covid-19 by Marketing

With the emergence of positive COVID-19 cases in infants over the past several months, how should the care manager support expecting and newly delivered moms in their efforts to keep themselves and their babies safe from COVID-19?  A two-pronged approach that allows the mom to voice her concerns and fears while arming her and her household with the information they …