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ClaimSphere QaaS helps healthcare organizations gain a deeper understanding of their populations, deliver better care and reduce costs. Patient journey analytics allow you to decode patient-specific clinical events across disparate data sources and use patient data to identify key issues impacting scores. With this information, healthcare organizations can take corrective action to improve Healthcare Effectiveness Data and Information Set (HEDIS®) quality ratings.
The ClaimSphere QaaS footprint spans over 25 states and covers Medicaid, Medicare, Commercial and FEHB lines of business—addressing Retrospective, Prospective and Predictive Quality Improvement.
Retrospective Solution for Regulatory Compliance and Reporting
Enabling double-digit rate improvement with on-time and accurate reporting
Prospective Gaps in Care Identification and Closure
3X faster closure of care gaps with improved efficiencies and outcomes
Real-Time Data Streaming for Faster Insights on Care Gaps
Near real-time integration with industry-leading core claims engines, such as Facets®, enabling complex analytics over data in motion and reducing care gap generation cycle time by 95%
Predictive Analytics to Help With High ROI and Improved Member Experience
Targeting high ROI members for faster and focused interventions
Payer-Provider Convergence and Interoperability
Clinical intelligence at points of care with collaborative platform, Clinical+ enabling faster care gap closure
Secure Hosting Options With Unmatched Service Bureau Support
From secure hosting and NCQA audit support to unmatched support services by HEDIS subject matter experts, business and technology teams
End-to-End HEDIS Workflow Management is supported via a data integration and administration tool with a built-in data quality profiler that enables rapid data issue identification and rectification for improved efficiency. A supplemental sources audit trail is maintained for HEDIS compliance.
Self-Service Business Intelligence tools uncover the root cause of low HEDIS scores and help analyze poorly performing measures for appropriate action. Care gap and performance reports summarize provider quality of care and highlight disparities, while predefined reports and adhoc analytics support follow-up action planning.
Support Value-Based Programs and Faster Customer Rollouts with an expansive evidence-based measures library that allows you to create variations of "gold standard" measures. Develop and maintain sentinel medical events and construct custom measures using an intuitive user interface for faster customer roll-outs.
Rapidly Identify and Close Care Gaps Using Near Real-Time Integration with core claims engines such as Facets. Using the Facets Data Publishing tool, you can reduce data processing time, as well as care gap identification and closure by more than 95% to drive improved quality of care outcomes.
Enable Meaningful Provider Collaboration With Real-Time Actionable Intelligence via integration with ClaimSphere Clinical+. Provider abrasion is reduced through large-scale distribution of care gap insights in near real time to facilitate supplemental data collection from providers and empower payers with provider performance analytics.
Improve ROI with Quality Improvement With Predictive Analytics (QIPA). Disease condition-specific statistical models offer member-level propensity scores based on adherence to evidence-based clinical guidelines. Health plans can stratify gaps in care populations and implement intervention strategies to increase the ROI of quality improvement programs.
Maximize Quality Initiatives With a Full-Service Partner. From HIPAA-compliant cloud-based hosting services to world-class project management and support, Cognizant ensures on-track implementations and streamlined operations. RNs working out of a URAC-accredited facility are available to deliver onsite and remote chart abstraction services for hybrid measures.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).