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Clinical Data Plus Proactive Notifications Equals Improved Quality Measure Performance

Healthcare Payers

While a number of health plans have started to use clinical data as part of their quality measure strategy, many have yet to realize the benefit. Health plan quality departments still rely heavily on vendors for their medical record chart review or require their provider network to submit supplemental data through a portal. Both of these methods are costly and can create work for their provider networks. Furthermore, while these methods report on services already provided, they have little influence on the handful of time-sensitive measures such as Follow-Up After Emergency Department Visit for Mental Illness (FUM) that require timely coordination between payers, providers and patients to complete care within the 7 or 30 day windows.

In this session, learn how NYC based regional health plan Healthfirst has enabled their private Health Information Exchange (HIE) powered by InterSystems HealthShare Technology, to use the clinical data they are getting from their provider network as a supplemental data source that replaces traditional chart review and supplemental data submission while closing care gaps quickly. More importantly, learn how access to real-time event notifications through the HIE can enable plans to proactively notify providers of needed services on time-sensitive measures and improve compliance.

The topics at a glance:

  • Streamline your clinical Quality Measure Data Acquisition Process
  • Improve Quality Measures that have short windows to close Gaps
  • Reduce Cost around your Quality Program
  • Repurpose clinical data for other use cases such as UM or Risk Adjustment


  • Autumn Kerr, AVP, Clinical Quality, Healthfirst
  • Kate Beck, Director, Health Information Exchange, Healthfirst
  • Lynda Rowe, Senior Advisor, Value-based Markets, InterSystems

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