BHA Improving Quality Scores

One of the largest insurers in the country, a 5-state blue, knew their members were getting high quality care. But their Star Ratings and HEDIS® hybrid scores in Medicare Advantage weren’t showing that.  They asked Baltimore Health Analytics if we could help them and we did.

We have an ongoing engagement, but we wanted to share how we’ve worked together with BHA’s tools to markedly improve their quality scores.  The truth is, we’re more heavily engaged than ever, now working with their other lines of business.  It’s become a cliché to call clients “partners,” but the idea is very true here.  Their success is our success, and we’re proud to share a snapshot of how we’ve done so far.

Our initial interactions started with a small task.  Kick the tires of their existing processes and make some recommendations for HEDIS® improvement.  Second, provide reports to track whether they’re hitting the numbers they need to achieve both Stars goals and CMS’s statistically significant improvement in as many measures as possible.  Third, create a shadow chase list from claims to compare with chase list generated by the hybrid reporting system. 

From this, we demonstrated that a claims based chase list for labs would catch end of year labs and 3^rd party labs that the standard CDC chase list was missing.  “What use is that?” “We can automatically generate faxes based on the additional chases.” They replied, “Go for it”, and their A1C rates jumped an average of 13% in the first year.