NCQA has simply launched its 2023 well being plan rankings. These rankings are primarily based on well being plans that publicly report their high quality measures (through the Healthcare Effectiveness Knowledge and Info Set – HEDIS®) and represents about two thirds of your complete US inhabitants.
General, there’s a slight enchancment in efficiency from well being plans versus 2022 – particularly round well being fairness – the place 92% of plans reported the direct race and ethnicity measure – scoring most factors on this measure.
Two industrial plans obtained 5-star rankings – Kaiser Basis Well being Plan of the Mid-Atlantic States and Impartial Well being Affiliation (which is up from 1 plan final yr). No Medicare or Medicaid plans obtained 5 stars this yr.
With these rankings now launched, we are going to eagerly anticipate the October launch of 2023 Stars rankings to see if drop in efficiency final yr was a “blip”, with restoration this yr or if extra plans will see the publish covid affect on their rankings.
No matter general traits, in case you are a well being plan trying maximize your rankings, my sturdy recommendation is that you simply flip to expertise and AI options to make sure you are reporting precisely – and never being penalized for care gaps that exist on paper however not in follow.
How do you do that? With AI assisted medical report evaluate – as a well being plan, you’ll be able to improve the quantity and accuracy of supplemental knowledge or digital knowledge you evaluate and submit as a part of your high quality reporting. This use of such expertise has seen well being plans and ACOs improve effectivity of medical report reconciliation and evaluate by over 10x.
As we strategy HEDIS® season – it is not too late to make the increase you want with NLP.
If that is of curiosity to you – then please get in contact.
Linguamatics 
21 Sep 2023