Guest Blog: Advancing Clinical Performance with Strategic Quality Management

Delivering high-quality care is essential to succeeding in today’s evolving market. Well-chosen quality metrics and effective incentives in value-based contracts can lead to healthier populations by generating better clinical, operational and patient outcomes. However, high-quality ratings are difficult to achieve and maintain over time.

Lumeris simplifies quality management for health systems, payers and providers. Our value-based care initiatives and quality programs have improved performance for government-led Accountable Care Organizations (ACOs), Patient-Centered Medical Homes (PCMHs), Medicare Advantage (MA), and commercial programs.

We meet providers where they are on their journey to value-based care, utilizing readiness assessments that pinpoint opportunities to close gaps in care and manage chronic conditions specific to their population. We then work with the participants in the care continuum to map a course that prioritizes their goals, and helps guide them to achieve quality measures using our technology-enabled solutions.

Our comprehensive approach to quality management integrates strategy and tactics, empowering organizations to achieve remarkably improved clinical outcomes and publicize the benefits of being a high-quality health system, payer or provider group.

Started by physicians and the operator of a consistently high-rated MA Prescription Drug (MAPD) plan, Lumeris specializes in quality management. The following five lessons come from our expertise in managing access and availability, effectiveness and experience of care:

  1. Recognize the strategic impact of quality. Effective quality management transcends both business and care delivery and supports an organization’s overall value-based strategy. Ensure that your quality management approach includes both a strategic and tactical focus on achieving clinical quality.
  1. Align your provider management strategy with your quality management goals. Focus on high-impact areas by choosing a meaningful—but appropriate—number of quality measures. Offer ongoing support to providers and their care teams to help them meet quality measures.
  1. Make incentives meaningful. Aligning incentives across the care continuum is crucial for enabling sustainable behavior change. Worthwhile incentives for physicians encourage performance on quality measures.
  1. Remove barriers to care. Manage the effectiveness and experience of care by making it easier for patients to access care. Improve availability of care by removing financial, transportation and other barriers. For example, offer zero dollar co-pays for lab visits that support achievement of key clinical metrics.
  1. Create data transparency with the right tools and information. Equip payers and providers with powerful tools and actionable insights that offer a complete view of patients and populations based on EMR, claims, lab, and pharmacy data, as well as enhanced analytics. Provide the ability to stratify populations for quality campaigns and to utilize tailored patient outreach methodologies. With complete data transparency, providers are able to manage the effectiveness of care, including recommending necessary screenings and tests to close any gaps.

Our proven approach fosters greater collaboration between payers and providers, engages physicians and patients in healthy behavior change, and drives optimization of quality metrics in any value-based care model. Success in quality management depends on having a plan—and an experienced partner—for navigating your journey to business and care delivery transformation.

Read the Lumeris Quality Management Point of View today.