Digital Quality Dispatch: November
Astrata, Inc
We make purpose-built, industry-leading, HEDIS?-focused software for health plan quality teams.
Resources for health care leaders on their digital quality journey
November Newsletter: Post Election Turbulence
Whatever political side you are on in our deeply divided country, we know that quality leaders nationwide are focused on understanding potential changes to government programs on the horizon. While we anticipate changes under the new administration, we remain confident that the significant long-term investments the healthcare industry is making in digital quality will produce real value for health plans. All of us at Astrata are anchored in helping our clients to realize this vision despite the turbulence of recent months.
Population Health Alliance Webinar
Our CEO, Dr. Rebecca Jacobson participated in the CM Learning Networks panel discussion on “Leveraging technology & data analytics to improve case management in population health programs”. The CM Learning Network is a collaboration of the Population Health Alliance and Commission for Case Manager Certification. It was a fascinating discussion with two other panelists – Margaret Brown, DHA, MPH, BSN, RN, CCM , Senior Director of Care Management at Priority Health and Todd Glanton, MBA , SVP of Technology and Analytics at Monroe Plan for Medical Care , facilitated by Michael Barr, MD, MBA, MACP, FRCP .
You can access this special event at:
Access more video content: And if you’ve missed any of our previous webinars, you can always access them on demand here:
NCQA Guest blog
In our latest guest blog with NCQA, our Co-Founder and CEO, Rebecca Jacobson, dives into how health plans can revolutionize HEDIS operations through digital innovation. Key points include:
Read the full blog here below & share it with your Quality team!
Astrata News?
Recent Webinar: Transforming Prospective HEDIS through the power of NLP
Join us for an exclusive webinar presented by Astrata and Capital District Physicians’ Health Plan, Inc. (CDPHP?). In this webinar, you will learn of the impact of using an AI-driven prospective HEDIS solution on clinical quality rates, labor costs, and operations.
You can access the webinar online by registering here: On-demand Webinar Recording
Meet us at the 10th Annual Medicare Star Ratings & Quality Improvement Summit
You can also meet the Astrata team in New Orleans from December 3-5 at the Star Ratings Summit.
What’s next? We’re kicking off 2025 at the 8th Annual Medicare Advantage Leadership Innovations in San Diego, CA, on January 22-23. We look forward to seeing you there!
Good reads
If you are struggling to find a good novel to take on that winter vacation with you – look no further! Here are a few excellent reads that will go even better with a cozy fire and a cup of hot chocolate.
From our friends in government
This action plan from the Assisting Secretary of Technology Policy (ASTP), formerly know as ONC, paints the most specific picture to date of the next phase of FHIR capabilities and adoption. While the draft action plan is intended to align federal agencies, I think this is a must-read for every health plan analytics and IT leader. This phase (until 2026) lays out the state of all core components - production, balloted, pilot - and gives us a way to read between the lines about what’s coming next. Have a good look at all the pilots – such as Da Vinci Payer Data Exchange (PDex) and SMART Health Card. We can also see new capabilities being balloted that will likely comprise important components of the emerging TEFCA ecosystem.
Digital Quality
Identifying members with social needs that hinder their engagement with healthcare continues to be a critical need for healthcare organizations, including health plans. Several recent articles have highlighted the potential of large language models (a relatively new type of natural language processing model) to address this challenge. This paper by Ralevski et al., featuring authors from Providence Health & Services, Tegria, the University of Washington, and the Institute for Systems Biology, demonstrates that a commonly used LLM (GPT-4) performs well in identifying housing instability (stably housed vs. current housing instability vs. history of housing instability). The method shows higher recall (fewer false negatives) but lower precision (more false positives) compared to human abstractors. I think we can expect these LLM-based methods to offer an excellent complement to survey- and questionnaire-based approaches for identifying at-risk populations in need of outreach.
Measures of Interest
Blood Pressure Control
Several recent articles have outlined programs for BP control that utilize at scale population health methods. Here is another one from authors Deo et al (Atman Health, Brigham Women’s Hospital and Detroit Association of Black Organizations). While the setting may be significantly smaller than populations managed by most insurers, the overall premise seems generalizable. The HEDIS CBP goal was achieved within 12 weeks for 69% of enrolled participants.
Big Picture
Despite much effort to the contrary, the use of low-value services persists among older Americans, leading to increased costs with limited benefits and, at times, significant harm. Medicare Advantage (MA) plans have strong incentives to limit the use of low-value services, but are they effective in doing so, and why? This cross-sectional study by Duggan, Beckman, and Ganguli (Harvard) examines whether significant differences exist between MA and traditional Medicare, and whether these differences are consistent across MA parent insurers. The study finds that overall utilization of low-value services is lower in MA plans compared to traditional Medicare plans from the same parent insurer. However, significant variation exists among plans.
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