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Clinical Care Quality

For ACO REACH Organizations, Medicare Advantage plans and healthcare providers the importance of achieving a CMS 5 Star Rating cannot be overstated. With the number of plans with over 4 Stars Ratings falling by 17% in just one year, and with more than 70% of enrollees choosing to participate only in plans with higher ratings, it is crucial to track and improve performance on every quality measure. This is where Saince comes in.

At Saince, we offer a unique combination of technology and services that can help you stay on top. Our team has extensive experience working with plans and healthcare providers to optimize performance on every quality measure. With our help, you can achieve a higher CMS Star Rating and improve patient outcomes.

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Medicare Advantage with prescription drug (Part D) coverage (MA-PD) contracts are rated on up to 38 unique quality and performance measures; MA-only contracts (without prescription drug coverage, or Part D) are rated on up to 28 measures; and stand-alone Part D (PDP) contracts are rated on up to 12 measures. Our team can help you accurately track performance on each of these measures and develop targeted strategies to improve outcomes.

Additionally, guardrails were introduced in the 2023 Star Ratings for all measures that have been in the Part C and D Star Rating program for more than three years except the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey and the Part C and Part D improvement measures. Guardrails are bi-directional caps that restrict upward and downward movement of a measure’s cut points for the current year’s measure-level Star Ratings compared to the prior year’s measure-threshold specific cut points. Our team is highly knowledgeable about these guardrails and can help you navigate the complex regulatory requirements to ensure compliance and optimize performance.

By working with Saince, you can have peace of mind knowing that you are taking advantage of the latest best practices in healthcare delivery. Our team can provide guidance and support to help you improve patient outcomes, optimize revenue streams, and achieve a higher CMS 5 Star Rating. With our help, you can stay ahead of the competition and provide the best possible care to your patients. Don't wait, choose Saince today and let us help you achieve your goals!

Frequently Asked Questions

Clinical quality in healthcare refers to the standard of care provided to patients, encompassing the effectiveness, safety, and efficiency of healthcare services. It involves evidence-based practices, adherence to clinical guidelines, and the continuous improvement of patient outcomes.

Clinical quality is measured through a combination of quantitative and qualitative indicators. Key performance metrics, patient outcomes, safety records, and adherence to established protocols are assessed to gauge the effectiveness and reliability of clinical care within healthcare organizations.

Clinical quality directly influences patient outcomes by ensuring that healthcare services are delivered with the highest standards of safety and efficacy. Adherence to clinical quality standards minimizes errors, enhances treatment effectiveness, and contributes to improved overall patient health and satisfaction.

Healthcare professionals play a crucial role in enhancing clinical quality by staying updated on evidence-based practices, participating in continuous education, and actively engaging in quality improvement initiatives. Effective communication, collaboration, and a commitment to best practices contribute to elevating clinical quality standards.

Technology plays a pivotal role in advancing clinical quality through electronic health records (EHRs), data analytics, and telemedicine. These tools facilitate real-time access to patient information, support evidence-based decision-making, and enable healthcare providers to monitor and improve clinical outcomes efficiently.

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