Health Plan Quality Improvement and Member Engagement

July 30, 2019 Jeanette Stern

As mentioned in previous articles, the healthcare system has transitioned from a fee-for-service payment model to a value-based payment model. What does this mean for a health care provider? This means that health care providers will receive compensation based on their aptness to improve and enhance the health of their patients. 

However, how will you know if health care providers are improving the overall health of their patients and the patient community as a whole? Well, there is a quality rating system that is used to make sure health care providers, healthcare facilities, health plans, and others in the healthcare industry are meeting the standards and regulations that have been set for the healthcare industry.

For instance, there are certain standards and regulations that must be complied with if you offer Medicare services and Medicaid services. If you receive high-quality scores and ratings this means you are having a great amount of success in regards to member health. Are there things you can do to ensure you improve your overall quality ratings? Are there areas that can be improved upon as it relates to health plan members, chronic illnesses, diseases, and treatment? Yes. 

Understanding The Quality Measures

Health care providers should become familiar with all the quality measures that have an impact on them. As a health care provider with a specialty, you should be aware of all the measures that relate to your healthcare specialty. If you truly want to understand the quality measures that need to be improved upon, there is one vital thing that you will need to do. You will need to obtain a better understanding of all the data you are surrounded by. Also, you will need to have a clearer understanding of what each data set means and how that data can be used to improve health outcomes. Greater change can occur when healthcare providers focus on certain areas of healthcare, including providing care patients can afford, improving communication, providing better safety, and disease prevention.

Interactions and Communication

If you want to create a strategy that can be used to improve healthcare, you will be able to take steps to improve communication. It is important to remember that health plan members will use a variety of communication methods, including mobile applications, social media, email, text messaging, voice messaging, mail, phone, and more. When you are able to create a user experience that is favorable and impeccable, you will see improvements in your overall member engagement. You will see an increase in the engagement because you have made it easier for your members to interact and make their way through the health care process. 

Providing Services To Patients With Limited Access

How often do you take part in health screening services and programs? We know that this will involve a great number of interactions and navigation, but it is something that is needed. Health plans will need to find members who are resistant or unwilling to be active in their health care. Once these members have been identified, health plans should take an active approach in finding the health care providers so tests can be conducted and patient records can be conducted. Once this data has been obtained, it can be placed in the proper system.

Health plans can create files that will consist of relevant information about the members who have failed to remain compliant. Once this information has been effectively stored in the healthcare system, members who have not been compliant when it comes to member engagement, care, treatment, etc. can be sent information through one or more communication methods. After the members receive the information through their preferred method of communication, they will be able to fulfill their obligations, meet their suggested objectives, and start making improvements to their health.

Health care providers and health plans that have an interest in engaging their members through interactions, better treatment, screenings, and more will have a greater level of success when it comes to increasing their quality scores. If you would like to learn more about quality score ratings and member engagement or if you would like MedXM to help you implement an effective quality improvement strategy, please do not hesitate to contact us today.

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