Quality

Improve quality measure performance

Rising medical costs, affordability pressure, new reimbursement models, increased regulatory requirements, and public reporting of quality metrics, have shifted how plans view the importance of a quality focus. As a result, plans today focus on:

  • Service level excellence
  • Access and availability of care
  • Payment for value
  • Stakeholder experience and clinical performance

By improving clinical quality performance, health plans improve health outcomes and reduce the cost of care. This positions them as preferred partners for public sector enrollment and as a preferred health plan for members and employers during annual coverage decisions. Higher quality scores also have direct links with higher reimbursement rates from government programs.

Optum enables health plans to take a proactive, integrated approach to quality, helping them:

  • Enhance medication adherence
  • Improve Star ratings
  • Collect and report HEDIS® measures

Compliance

Meet compliance requirements with ease


In response to Health Reform-driven changes, health plans are developing new approaches to help improve quality, track, and report important dimensions of cost and service, and document member disease burden.

Data and Reporting

Boost Star ratings, improve HEDIS® performance and enhance clinical quality initiatives  


Real-time reporting and analytics are critical to evaluating the impact of Stars measure improvement initiatives. The Optum™ Stars Management Platform®  provides the information health plans need to manage Stars improvement programs.

Medication Adherence

Predict and prevent medication non-adherence


Medication non-adherence represents the leading cause of morbidity, mortality, and health care cost. Furthermore, the Medicare Advantage Stars ratings now include heavily weighted medication adherence measures, making this a key priority for both health plans and the Center for Medicare & Medicaid Services (CMS).

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An Optum professional will contact you within one business day. If you have additional questions, please contact us at 1-800-765-6807 or empower@optum.com.