First few Article Sentences
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.