When it comes to compliance, there are SO many factors to consider. Let’s take the NCQA Ratings for instance. Yes, getting your members engaged is important but NCQA gives three main categories that make up your NCQA rating. You may be saying, “we already know this Hannah…” But have you thought about how your engagement platform impacts your ratings?
When health plans look for platform and/or portal vendors they typically focus on operating efficiency or savings related to admin functions, and tend to overlook how these solutions can help improve quality ratings and compliance. A comprehensive engagement orchestration platform can help to meet a number of factors tied to NCQA.
A Quick Review of NCQA
Ratings consist of three major performance categories: consumer satisfaction, prevention and treatment. Let’s look at each category a bit more.
- Consumer Satisfaction: What patients say about their health plans in satisfaction surveys, including about claims processing and customer service
- Prevention: Checkups, tests and other care that keeps people—especially children—healthy
- Treatment: How consistently a plan provides scientifically recommended care for common, costly conditions such as diabetes, depression, and heart disease
Just like most of your online experiences, the NCQA ratings ultimately provide a simple, user-friendly 1-5 scale, where 1 indicates lower performance and 5 indicates higher performance. By grouping plans into a few broad categories, the ratings give consumers a practical, meaningful guide to understanding their health care choices.
Questions to ask yourself when choosing an engagement orchestration platform and reaching your NCQA goals
Each major performance category has markers that can help you maintain or raise your NCQA ratings. These markers are great questions to ask your engagement platform vendor or to use when searching for a vendor.
- Will you send surveys and collect data on a regular basis?
- Is it easy to access and understand eligibility, benefit and claim information?
- Can you provide flexible options to deliver plan documents, ID cards, and notifications?
- Will you be easily available for your members to contact including via secure messaging and chat?
- Will you provide a robust provider directory with updated information including who is accepting new patients?
- Is it easy to navigate and provide a positive member experience?
Prevention & Treatment
- Can you notify members when preventive screenings are needed like well exams and vaccinations in their preferred communication channel?
- Can you notify providers and care managers through alerts, notifications and dashboard reports when their patients require a preventive exam or test?
- And are there reporting capabilities for them to contact members about these services?
- How can you let members know the cost of care?
- Does it provide multichannel interactive communication channels including email, web, mobile?
- Can you notify members when gaps in care are identified for chronic disease like diabetes, asthma, and heart disease in their preferred communication channel?
- Can you notify providers through alerts, notifications and dashboard reports when their patients need a gap in care closed?
- Does it provide tools for care teams to collaborate on the care of a shared patient?
- Does it provide tools to identify and direct when more efficient care could have been received?
- Does it include provider quality reporting dashboards?
A comprehensive engagement orchestration platform provides the functionality, and member and provider experience necessary to impact NCQA quality and compliance ratings. Download your free copy of our ebook, Raising the Bar: How Technology Helps Health Plans Meet Compliance Standards, to learn more about how engagement orchestration platforms can help you achieve your compliance rating goals.