Maximize Your Performance and Increase Reimbursement

The shift from reporting-based to performance-based clinical quality measures has demanded robust data capture, integration, continuous measurement and comparison against performance benchmarks.  Process and outcome measures crossover into Medicare, Medicaid and Commercial programs as organizations manage their adult and pediatric populations with the same evidence-based guidelines. Successful payer and provider organizations recognize the importance of timely measurement, integration of both clinical and financial data and the ability to engage with providers to improve clinical coding and quality action capture in the EHR.

SPH Analytics is a CMS-approved Quality Registry that can extract and aggregate clinical data from multiple EHR systems and payer files, calculate quality measures, and compare your performance against national benchmarks. The data collection process is streamlined to alleviate labor-intensive, manual processes for practices and providers. The solution helps providers gain visibility into their quality measure results throughout the year so proactive steps can help improve performance for MIPS submission or commercial payer reporting.

Additional Solution Benefits:

Patient lists to close gaps: Enable your providers with patient lists to close care gaps and improve quality metrics during workflow.

Multi-payer quality improvement: Calculate and report on measure performance across Medicare and non-Medicare patients to support all payer quality improvement initiatives. Ability to build custom commercial measures available.

Provider comparison: Compare measure performance and patient contribution across providers.

Maximize payments: Achieve quality metric goals to maximize value-based reimbursements, avoid financial penalties, or earn shared savings and bonus payments.

HEDIS® Performance and Care Gap Reporting

Quality Measures HEDIS

Our Quality Measures HEDIS analytics leverage SPH Analytics’ NCQA–certified measure engine to calculate measure performance, while generating care gap reports throughout the year. The interactive measures dashboard lets healthcare organizations track and compare performance across their population. To further drive quality improvement, organizations can define and share cohorts for targeted population health action. Quality Measures | HEDIS includes:

Product Features

  • NCQA-certified HEDIS measure engine
  • Library of certified HEDIS measures
  • Patient cohort stratification
  • Exportable Care Gap report
  • Continuous monitoring of open/closed care gaps across population
  • Ability to set quality performance goals
  • HEDIS supplemental data pull from EHRs

Medicare for MIPS

Quality Measures Medicare

The Quality Measures™ Medicare module is for individual providers and groups participating in the Merit-based Incentive Payment System (MIPS) or an Alternative Payment Model (APM).  Clinical data across all payers, can be aggregated and normalized across multiple EHR source systems and used to calculate clinical quality measures.  A convenient dashboard allows network administration or individual providers access to view and analyze performance throughout the year.  Performance rates are compared to CMS benchmarks to establish goals and understand improvement opportunities. For MIPS eligible clinicians, data on MIPS Quality, Improvement Activities and Advancing Care Information categories can be submitted to CMS to comply with MIPS data submission requirements.

Product Features

  • Library of registry-based measures, eCQMs and ability to build custom measures
  • Compare performance to published CMS benchmarks and identify CMS Decile achieved
  • Calculates points per measure and the numerator count to achieve the next CMS Decile
  • Flags measures not meeting minimum MIPS measure criteria
  • TIN/group level or individual provider/NPI level reporting
  • Ranks provider scores across the TIN/group
  • Drill down to actionable patient work lists
  • Annual MIPS individual or group data submission to CMS

Commercial & Medicaid

Quality Measures Commercial & Medicaid

The Quality Measures™ Commercial & Medicaid modules help provider organizations who are engaged in multiple value-based and pay-for-performance arrangements maximize their bonus payments and revenue potential.  The solution aggregates and normalizes EMR data, care gap, membership roster and last visit data from multiple payer plans.  This alleviates administrative burden spent on consolidating reports and distributing them to providers, but also provides visibility on care gap and attribution data that can be reconciled with the payer.

Product Features

  • Monitor open/closed care gaps across all payers and set performance benchmarks
  • Compare performance across plans and providers
  • Drill down to actionable patient work lists
  • Calculate top network level performer
  • Provider engagement and education on coding to close gaps
  • Member roster management and identification of members at risk for attribution loss

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