How to maximize ROI from your quality improvement programs

Health plans know that the cost of a successful quality improvement program can be substantial. Working across your provider network to implement care gap closure interventions, developing effective incentives for providers, and conducting all of the associated administrative work produces costs that add up. Still, with member health outcomes on the line, as well as stringent regulatory requirements, plans have no choice but to prioritize quality improvement in healthcare.

Fortunately, there are ways health plans can generate additional value from their quality improvement programs, ways that not only help achieve the goal of improved quality of care but that also deliver a return on investment (ROI). To maximize ROI, take a strategic approach to QI that encompasses advanced technology, performance prioritization, and deliberate engagement strategies. The result is increased efficiency and improved outcomes across your member population.

Make QI count: High-impact strategies for better outcomes and ROI

Successful QI programs don’t have to break the bank. By taking a deliberate, data-driven approach to prioritizing your QI work, you can successfully meet your plan’s quality goals while also increasing efficiency.  

Pinpoint quality interventions with high accuracy

One of the biggest challenges in QI is understanding when and where to target interventions. Working with providers to determine QI priorities and implement effective strategies to close care gaps is often tangled up with incomplete data and competing priorities.  

Thankfully, healthcare AI technology can provide the data that health plans and providers need to jointly prioritize care gaps for intervention. AI-powered technology can generate clinical insights with up to 99% accuracy, offering suggested diagnoses at the point of care so that providers can more easily make informed treatment decisions. The technology helps bring high-priority diagnoses to the forefront, including chronic conditions and other high-cost illnesses that are the most likely to benefit from clinical interventions. That way plans and providers can work together to detect patient health conditions before they escalate and generate high-cost interventions down the road.

Focus on HEDIS measures

When health plans have a comprehensive HEDIS strategy in place, it can help drive significant ROI. First, prioritization of HEDIS quality measures can directly increase Star Ratings since CMS uses HEDIS in its calculation of Star Ratings. And high Star Ratings have a significant impact on health plan success. A high score can help attract new members to your plan - increasing Star Ratings by one point yields up to a 12% increase in enrollment.

Star Ratings and high HEDIS scores also leave plans eligible for additional direct sources of revenue. Last year, CMS awarded quality bonuses to eligible plans from a pool of $11.8 billion. Prioritizing HEDIS measures in QI work not only improves compliance but has a financial upside that health plans would be unwise to ignore.

Take a proactive approach to member engagement

Being deliberate about increasing member engagement has a huge upside. Plans have demonstrated that actively engaging members in their care can reduce medical costs by 5.3% and hospitalizations by 12.5%, meaning that by focusing more on member engagement, you can reduce the total cost of care and improve member health. This is because engaged members are better at navigating healthcare decisions and are more likely to adhere to treatment.  

Active member engagement strategies often entail significant resources like staff time, communications, and advanced member data management. The good news is that technology can automate and accelerate these processes to minimize the resources it takes to drive member engagement. For example, advanced member management software can automatically generate personalized communications at customizable cadences to help keep members informed and engaged in their care.  

By centralizing multiple data sources into one 360-degree member view so that member data is accurate and up to date, it's far simpler and more efficient to maintain communications with members and send them information specific to their unique health situation. The result is that your members are more satisfied, knowledgeable, and active in their care, all of which go far to improve quality-of-care outcomes.

Consider innovative ways to engage clinicians

Health plan QI teams know just how critical clinical engagement is to the achievement of their quality goals. Engaged clinicians are the powerhouse behind any successful QI effort, doing the groundwork to close care gaps and engage patients directly at the point of care.  

Health plans can increase clinician engagement in their QI efforts by working to align incentives. Clinicians who directly share in the benefits of improved quality outcomes will be more motivated to collaborate on specific quality priorities.  

You can also drive increased clinician engagement with increased access to data: data that’s more comprehensive while also being more digestible. AI-powered technology can integrate seamlessly into EHRs at the point of care, flagging potential care gaps along with supporting evidence so that clinicians can make more informed treatment decisions. Working with providers to implement technology that reduces administrative burden while also adding value to the patient encounter results in more engaged clinicians, clinicians who can better focus their expertise and attention on achieving QI goals.  

Reduce your administrative costs

Automating critical QI processes can transform entire QI programs by reducing manual tasks without sacrificing accuracy. Processes like medical record retrieval and clinical review generally require massive investments of time, time that clinical documentation integrity (CDI) specialists and other staff could better spend focusing on validating the toughest cases.

Advanced technology can be a game-changer when it comes to reducing these administrative costs. AI-powered medical record retrieval can integrate with disparate data sources and seamlessly centralize data into a single member-centric view. And it does so up to 80% faster than traditional retrieval methodologies.  

AI-powered technology can also increase abstractor efficiency by 75%, pointing out coding discrepancies and care gaps to help target abstractors’ time. Simply by introducing leading technology, health plans transform the way QI processes function to save time, resources, and generate ROI.

Continuously monitor performance

Finally, successful QI programs depend on access to real-time, accurate data. Being able to track specific metrics, narrow in on provider performance, and monitor trends on a weekly or even daily basis is essential to targeting interventions and allocating QI. Better, data-driven targeting of QI resources ensures interventions are more likely to help you improve outcomes and increase ROI.

The benefit grows when dashboards, reports, and more are easy to share securely with providers to help keep them abreast of progress and motivate performance improvement initiatives. Technology that facilitates real-time data sharing in multiple formats should be foundational to any successful QI program.

Selecting the right technology partner for maximum ROI in QI

Quality improvement is a critical function of any successful health plan. However, without smart strategies incorporating the use of advanced technology, it can put a substantial drain on your resources. Fortunately, innovations in technology are transforming the way health plans conduct QI - and they're reaping the benefits in terms of ROI.

Reveleer’s value-based care software solution, for example, brings together innovative, AI-powered technology that powers QI programs along with risk adjustment and member management. It builds a cohesive, member-centric data source and introduces intelligent automation to deliver substantial ROI.

Interested in a QI technology partner that can help achieve 6X ROI? Schedule a demo of Revleeer’s Quality Improvement Solution to experience:

• Clinical insights delivered at the point of care with 99% accuracy

• Thousands of hours saved on medical record retrieval

• Point-of-care technology integrations with leading EHRs