High-Level Quality Measure View and Drill-Down Capabilities

At Mile High Healthcare Consulting, we are very active in both the quality measurement and risk adjustment realms.  Our marquee product, Cortex-QM—fills a niche in the market with the flexibility to address quality issues across all lines of business while having the unique ability to focus on areas of actionable need.  “Everyone” has quality improvement scorecards- what is lacking is the ability for an issuer to chart their course to a particular quality rating, be it in Medicare (Stars or Shared Savings ACOs), Marketplace (QRS), or Medicaid managed care quality performance indicators.

  • Tailor measure sets by domain and plan, set targets, and vary the number of “stars” (or quartiles, quintiles) depending on the quality improvement program you are tracking.
    Build multiple scenarios for compliance tracking, with each scenario comprised of its own measures, cut points, domain definitions, ROI, etc. Mile High has preloaded measure sets for MA Stars, the
  • Medicaid core measure sets for adults and children, and the commercial QRS measure set.  Dynamic cut points can be implemented by stating an across-the-board percent change or by entering star-specific cut point thresholds. Managed Care Organizations seeking success in Medicaid states will need to be nimble in adjusting to the measure sets chosen by each state (they are all different!).   Cortex-QM’s scenario builder allows the user to build a custom suite of measures to monitor, track, and act on over time.  State-based and national norms are incorporated into Cortex-QM allowing comparisons to regional competitors or to use as benchmarks challenging local groups to up their game.
  • Highlight the subset of actionable measures that are lagging in your plan- while hiding, not ignoring, the other 30+ measures that have not significantly changed this month. Cortex-QM’s Dynamic Scorecard can produce focused scorecards customized to each provider or group.  By highlighting the handful of measures a provider group needs to focus on now, while not displaying extraneous information that is not actionable makes the Dynamic Scorecard a component of Cortex-QM’s next generation QI platform.
  • Track numerator and denominator hits, at the measure, member, or provider levels. Who are the providers that are holding you back from the achieving the next threshold?

Integrate Cortex-QM with HEDIS Cortex-QM can be populated each month by Mile High’s HEDIS engine.  If you have your own HEDIS engine or rely on another vendor’s system, Cortex-QM loads member-level numerator/denominator “hits” as well as compliance rates aggregated to the level of the plan or the particular scenario you have built.  Cortex-QM is the perfect companion to support an existing quality improvement program!