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Carla D'Angelo, Vice President, Cope Health Solutions Evan King, Principal and Chief Operating Officer, Cope Health Soltuions

Payor-Provider Partnerships are the Cornerstone of Improving Health Plan Quality Scores

By Carla D'Angelo
Vice President, COPE Health Solutions
By Evan King
Principal and Chief Operating Officer, COPE Health Solutions

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Original Publish Date: January 14, 2020

Payors of all stripes are increasingly holding health plans accountable for moving the health care system from the horse and buggy era to a “transportation network” for entire populations. The Centers for Medicare and Medicaid (CMS), state government and employers have heightened expectations for health plans to do more to achieve specific and complex quality outcomes.

Quality performance is now a key differentiator in Medicare, Medicaid and other programs to distinguish high performing health plans, health systems and medical practitioners. Furthermore, as more payments are shifting to value-based payment (VBP) arrangements, integrated delivery systems and health plans have significant revenue and membership tied to quality performance on key metrics – necessitating specialized resources and coordination to manage effectively. Achieving high quality ratings in HEDIS, CAHPS and STAR1 programs requires an integrated approach across care delivery “enterprises” that focuses on clinical outcomes, patient/member experience and accessibility of services.

Health plans do not “do” quality per se, instead, they resource and empower health professionals to greater achievement on those metrics. Health plans can exhort and penalize providers but, in general, they cannot directly implement quality programs in physician practices and hospital systems. Since health plans do not provide direct patient care, they must provide critical information, supplies and support to their network practitioners so that they can deliver leading edge performance under quality ratings. The role of a health plan is to outline requirements, promote high quality behaviors, share information and data with providers transparently, resource the infrastructure to build properly and remove barriers to improved practitioner performance. Health systems and physician practices require these strong partnerships to improve operational processes and workflows, as well as to revamp care delivery models to strengthen their organization’s value proposition to their payors.

Health plans can help to identify barriers to high performance at the physician and hospital levels that aggregate to sub-optimal health plan performance. These questions identify key components in the health plan’s role to enable quality improvement:

Health plans must step up to become strategic advisors and partners to enable providers to have the successes that ensure their own success under quality and value-based contracts. Health care practitioners and health plans should share seats at the table for discussion around consolidating resources and support that will help both entities improve on all quality dimensions. This “co-opetition” is crucial for sustainable results and lasting impact.


1 HEDIS stands for Healthcare Effectiveness Data and Information Set. Employers and individuals use HEDIS to measure the quality of health plans. HEDIS measures how well health plans give service and care to their members. Consumer Assessment of Healthcare Providers and Systems (CAHPS) is a series of patient surveys rating health care experiences in the United States. STAR Ratings give an overall rating of the plan’s quality and performance.

Carla D’Angelo joined COPE Health Solutions as a Vice President in 2016. She has more than 10 years of leadership experience in the health care industry with a primary focus on health plan and provider collaboration. Prior to joining COPE Health Solutions, Ms. D’Angelo served as the senior vice president at YourCare Health Plan, a low-income health insurer in Western New York. In this role, Ms. D’Angelo led the New York State Medicaid Delivery System Reform Incentive Payment (DSRIP), value-based contracting, marketing and quality efforts. Ms. D’Angelo also served as the senior vice president of administration at Trillium Health, a Federally Qualified Health Center (FQHC) Look-a-Like in Rochester, NY where she led the health center through their FQHC application process. Additionally, Ms. D’Angelo ran the 340 B pharmacy, marketing and organizational advancement departments, human resources and organizational strategy and board relations. Ms. D’Angelo also served as the interim CEO for the organization. Ms. D’Angelo spent seven years at Excellus BlueCross BlueShield, most recently as the director of financial services, consulting.

Evan King is the Principal & Chief Operating Officer. Mr. King has led numerous complex assessment, strategic planning and transformative implementation engagements throughout California, Texas, Washington State, New York and other parts of the country. As COO, Mr. King has guided the development of key services to assist clients and partners in preparing for local, state and federal reform, with a particular focus on clinical integration, value-based payment readiness, financial modeling and population health analytics. This includes the development of the cloud-native Analytics for Risk Contracting platform which helps achieve optimal value and performance for health care organizations currently in or planning to move to risk-based arrangements.