Quality Improvement Simulator

Meeting and exceeding CMS quality standards has never been more important for providers and plans alike. Since the institution of the Medicare Advantage Star Rating system, scores have been steadily rising as players across the healthcare ecosystem recognize the impact of these ratings on both consumer choice and profitability.

Accurately Calculate the Impact of Potential QI Strategies

Now, with the Mile High Healthcare Consulting Quality Improvement Simulator (Cortex-QM), Quality Improvement teams have a powerful tool to develop effective strategies and measure performance trends.

The Cortex-QM application is pre-populated with each plan’s CMS reported scores for each of the 47 measures that are used to calculate overall Star Ratings. This includes all 32 part C measures and 15 part D measures across all clinical, administrative and survey categories. Users see both the current ratings and the weight for each measure to help prioritize where to focus quality improvement efforts.

Users can simulate up to three quality improvement scenarios by selecting specific measurements and adjusting either the Star Rating or the percent of patients with numerator compliance. Specific improvement plans can then be created around the metrics that will have the largest impact on overall scores. Trade-offs are easily calculated to take into account the importance of individual measures, the upside potential and the plan’s ability to positively impact compliance.

See What it Takes to Impact Individual Measures

For each measure, information will be available to drill down to the group, provider and individual level to help assess what actions will be needed to affect change. They will even be able to download lists of target patients that need to take action in order to meet specific goals by metric. Plans will be able to advise providers how their scores compare to benchmarks and provide incentives and education to meet specific quality improvement goals.

The Cortex-QM application can be continually updated to reflect current regulations and CMS Star Rating calculation changes. Users update data monthly to calculate actual scores which they can compare to saved scenarios or performance snapshots to determine if quality improvement initiatives are having the expected impact

Cortex-QM from Mile High Healthcare Consulting takes the guesswork out of developing and executing an effective quality improvement strategy. Call Mark McKeown today at 720-446-7785 x106 to schedule a demonstration.