Enhance Quality and Performance Reporting with the Right Partner


Defining vision for your health plan is one challenge, finding a partner to help fulfill the vision is another. A well-defined Request for Proposal (RFP) can help guide the conversation to determine if a new solution addresses all regulatory, market, clinical and quality needs. To get you started, this series walks through the key points of building an RFP. Previously, we covered challenges of selecting a digital health partner with an RFP and the specific services a health plan should require from a vendor.

Quality and performance reporting is a necessity in healthcare and it’s changing how you work. Not everyone on your team needs to be versed in digital quality measures (dQMs), Fast Healthcare Interoperability Resources Application Program Interfaces (FHIR APIs) or Electronic Clinical Data Systems (ECDS), but your vendor needs the know-how to support you with skills in measure computations, summary ratings, and Reward Factors.

We’ve outlined five areas related to performance reporting and measurement a health plan should evaluate during the RFP process. We’re giving insights on creating an RFP that will help you select a tech-savvy partner capable of simultaneously monitoring and managing every element of improvements.

Collect the Necessary Data

Performance measurement is vital – it’s how plans monitor performance throughout the year to know when and how to adjust course to meet quality measurement goals and qualify for the Centers for Medicare & Medicaid Services (CMS) bonus payments.

Look for a partner who can collect accurate information and gather it in a variety of formats like self-attestation, claims data, or surveys. Define reporting standards within your RFP to help determine if the vendor monitors clinical, quality and financial performance, and knows what data to collect – especially when it comes to all-important member sentiment surveys.

To get a holistic view of members’ health, your plan needs data from departments as well as directly from the member via self-attestation and third-party sources including health coaching, biometric screening, disease management, meals, transportation, and other vendors.

Verify if a digital partner can integrate member data and needs across systems and departments. This allows your team to break silos so plan operations leaders can establish when to reach out to members to close care gaps in a coordinated effort. Coming together in this way can dramatically improve member experience and plan success.

Ensure Easy Access to Real-Time Dashboards

Digital technologies can have a big effect on a plan’s efficiency, member experience, and quality scores but the technology is only beneficial if you can use it. You need access to easy-to-use, real-time dashboards to monitor registration needs, survey results and quality measure performance, with the option to drill down into member-level data.

A well-designed dashboard can help you visualize data to see the big picture and drill down into specific measurement areas to support coordinated interventions based on results.

Use Surveying and Reporting Capabilities to Plan Interventions

Member feedback is one of the most important tools for successful plan performance. The industry continues to evolve as do the federal and state requirements. CMS is leading health plans to build programs that embrace the voice of patients and implement measures that prove those programs work. Your health plan covers a diverse population and your vendor must understand the members’ unique needs and how to best serve them.

Along the RFP process, be open to new strategies to address long standing issues and collect new, more accurate data. Identifying the diverse communities with a health plan requires the right digital tools for multiple types of surveys to gauge member sentiment and understand member health risks. An agile communication response deployed with appropriate, targeted interventions can effectively engage vulnerable communities in their healthcare.

The Medicare Advantage Star Ratings program also has a focus on data gathering resources. Plans must have the ability to leverage surveys to capture feedback, use sandbox capabilities, and gather and leverage self-attestation data and claims data to know when to take action, which communication channels to use and with which members to intervene.

In your RFP, specify a sandbox environment that gives you the flexibility to measure areas for growth and the creativity to influence member segments to reach the next Star level.

Monitor Program Performance and Intervention Success

After your member engagement strategy is put into action, the work needs to continue. A plan must measure results, adjust tactics, channels, and messaging to continuously demonstrate improvement.

An experienced vendor can monitor how interventions are performing, and report back if they’re inching plans closer to reaching plan performance goals. Expect a digital partner to take the time to drill down into member-level data and be there to help you evaluate the information and formulate a plan based on findings.

Plans should track campaign performance overall, and by single outreach, to measure program goals over time using real-time dashboards. You should know, for example, if communications are successfully reaching members or if members are taking the desired actions and effectively closing gaps in care.

Follow Security Protocols and Privacy Policies to Protect Member Data

If members trust you to submit their personal information, you need a partner with a depth of regulatory knowledge to protect their privacy. Use the RFP to determine if the vendor is proficient in CMS requirements and practices, Protected Health Information (PHI), HIPPA and  HITRUST certified.

Learn More and Prepare

In the coming weeks you can learn more about how to write an RFP to get the level of service your health plan deserves. We’ll share more information about the importance of finding a vendor ready to deliver in the following areas:

  • Supportive account management. Able to relieve staff from manual processes so they can focus in their areas of expertise. Support that fosters improved operational efficiency for staff.
  • Technical infrastructure and security. A digital-first mentality needs a strong base of data security practices and impeccable privacy protocols.

If you want to get started now, download the Healthmine RFP guide and checklist to learn how to prepare a request more efficiently for proposal and avoid common pitfalls with finding the right partner.

At Healthmine, we know that accurate and easy-to-access data is key to unlocking improved performance and annual quality bonus payments. That’s why we strive to ensure that Healthmine’s plan-facing dashboard, Opportunity Manager, provides health plans in all markets to surface key insights, drill-down capabilities for more specific member-level detail and an essential sandbox environment for Medicare Advantage plans to know exactly how to reach the next Star level. Our reporting capabilities help you achieve success key measures and work toward success in future measurement areas.

Download the RFP Guide and Checklist


Healthmine is the leading member engagement and rewards solution focused on empowering people to take the right actions to improve their health.

More Resources from Healthmine

More Like This