30 May How to Address Medicare Advantage Care Quality Issues

A new study has shed light on the importance of gathering more clinical data to evaluate the quality of care received by Medicare Advantage beneficiaries, particularly those with serious illnesses.

In a recent article published in the New England Journal of Medicine, researchers highlighted the lack of available data concerning the quality of care and the utilization of supplemental benefits, which are commonly used by individuals with significant health conditions.
The researchers also expressed reservations about the efficacy of the CMS quality bonus program, which rates the quality of Medicare Advantage plans and rewards high performing plans with bonus payments.

The core issue is that the program fails to adequately include enrollees with serious illnesses, such as those with dementia. Additionally, the data provided by CMS lacks granularity at the plan level, which hinders a comprehensive evaluation.

Fortunately, there is a solution for helping Medicare Advantage plans harness and aggregate more health data to gain a more comprehensive picture of the state of care quality for all beneficiaries.

The IMAT Flexible Payer Solution offers high-quality aggregated clinical data delivered in a more-timely basis through standard integrations. This capability enhances overall member care, reduces readmission rates, and increases disease management program eligibility.

By leveraging advanced data analytic capabilities, Medicare Advantage plans can also optimize patient interventions by predicting and preventing poor adherence. By accessing detailed patient trend insights, it is also possible to gain more insights into beneficiaries coping with serious illnesses.

In addition, the solution helps payers to improve overall HEDIS reporting capabilities and STAR ratings. Considering that the 2023 Medicare Advantage and Part D Star Ratings declined when compared to 2022, this is a key benefit for any payer looking to enhance their overall reputation.

Clinical Data Integration (CDI) is the foundation for the IMAT Payer Solution. In fact, IMAT Solutions was recently highlighted as a CDI vendor in Gartner’s “Clinical Data Integration Capabilities and Sourcing Recommendations for U.S. Healthcare Payers” report.

Are you ready to gather more data to evaluate the quality of care received by your beneficiaries? Unlock the full potential of clinical data integration and transform the way you manage patient care! Contact us to schedule a 20-minute demo with our expert clinical data integration team — boasting a combined experience of over 40 years.