Quality: An Investment in Our Members and Our Partners

A radical transformation takes place when we focus on equitable access to health care for our members. With it, we address their needs beyond clinical medicine. At the same time, we save our partners money. A fundamental and interconnected part of our care for the whole person model is our Quality Improvement (QI) Program.

We use evidence-based clinical guidelines, provider training and profiling, and actionable data to help members stay adherent with preventive practices and disease-specific protocols leading to healing beyond medicine. Our members have not had the benefit of the best clinical care or have had important services deferred.

Our program populations come to us below the NCQA 50th percentile or below a three-Star CMS rating. Through our data-driven and member-centric programming, we achieve the following outcomes:

  • NCQA performance increase to the 75th, 90th, and 95th percentiles
  • CMS Star ratings of four and five for provider-driven measures
  • Increased risk adjustment documentation capture
  • Improved member experience with their health plan and their care
  • Equitable access to health care for our members
Doctor sharing information on tablet computer with patient inside doctor's office

QI Program

Our QI Program is custom-built for each partner, leveraging our dynamic care for the whole person model’s core components for data, programs, engagement, and governance. To maximize collaboration, we engage in tailored evaluation cycles with each partner, ongoing planning and performance workgroups, and precision-targeting for intervention and data capture. Our program is made successful through our deep integration with our clinical and operations team members at every level of the organization. The QI Program includes features such as:

Quality Programs

Read How:

  • Quality Event and Member Engagement Program
  • Quality Education and Engagement Program
  • Administrative and supplemental data capture processes to reduce the reliance on chart chase
  • Tailored clinical and operational workflows for each quality measure

Quality Goals

Read How:

  • State and partner quality strategies to address all priority and focus measures
  • Performance Improvement Projects (PIPs) participation and pilot leadership
  • Longitudinal preventive care while addressing subacute needs
  • Holistic condition management for sustained health outcomes
  • Utilization management for appropriate cost reduction

Process Improvement

Read How:

  • Continuous Quality Improvement (CQI)
  • Plan-Do-Study-Act (PDSA) for evidence-based interventions
  • Lean Six Sigma to increase workflow optimization
  • Focused studies to pilot innovations

Performance Management

Read How:

  • Member and provider-level tracking and trending
  • Care team monitoring, education, and coaching
  • Regular quality and risk adjustment chart auditing and claims coding review
  • Forecasting for early identification and planning
  • Community analyses for heat mapping and impact studies

Our Quality Program in Action

Before AbsoluteCare intervention, our traditional member population scores in the lower 30th percentile with most quality- and value-based purchasing outcomes. After AbsoluteCare intervention providing equitable access to health care, our members have an increase in their quality- and value-based purchasing outcomes into the 80th-90th percentile. Our culture demands that success be tied to quality- and value-based purchasing performance.

23%

Reduction in Inpatient Admissions

23%

Reduction in Inpatient Days

16%

Reduction in Emergency Department Visits

10%

Reduction in Specialist Visits
Doctor in blue scrubs reading off of tablet while speaking to patient

Our Quality Program in Action

  • Pharmacy
    • Improved adherence and dispense rates through our onsite Pharmacy
    • Four-Star and above performance in key medication adherence measures
  • Outcomes – Chronic Condition Management
    • Improved outcomes for all measures under our care
    • Consistent performance in the 90th percentile for our engaged populations
  • Engagement – Hard-to-Reach Members
    • 97% annual wellness visit rate for a high unable-to-contact population