Quality Optimization
Centauri helps Medicare Advantage and Commercial health plans achieve optimal performance and gain a competitive advantage in their HEDIS® and Star Ratings programs through our Quality Optimization solution.
Current requirements call for health plans to retrieve and transmit clinical information about their members to providers in their network. For example, primary care providers (PCPs) of patients with two or more chronic conditions must be notified of their patient's discharge within 48 hours after emergency room visits and assess the rate of unplanned acute readmission after discharge.
Exchanging clinical information for quality programs and value-based care has always been a fragmented, labor-intensive, manual process resulting in missed care opportunities, unnecessary costs, and friction between payors and providers.
Real-time coordination is essential for quality, Stars, and value-based care success.
Centauri replaces costly, manual workflows with standards-based connectivity, exchange, and data formats that eliminate provider abrasion, optimize cost, and effectively leverage data. Our workflow optimization expertise translates into higher scores, better reimbursements, and more incentives to health plans.
Key Differentiators
- Real-time, bi-directional data exchange and intelligent event processing
- Closed-loop provider engagement and audit-ready data provenance
- Leverages established flows for monitoring admission/discharge data, querying for patient charts and integrating into the health plan enterprise systems
- Drives measurable financial impact by improving Stars and HEDIS scores, closing care gaps, and reducing avoidable utilization
- Seamless integration across major interoperability frameworks
- Reduces medical costs through earlier intervention and minimized duplicative testing while elevating member outcomes
- Enhances risk and quality accuracy with real-time data capture.
Streamline Data Retrieval Workflows
Our demonstrated experience in the clinical data exchange space enables us to support complex high-value use cases and bi-directional exchange. Additionally, our nationwide alerting and chart retrieval network uniquely positions us to assist healthcare entities with new Star and HEDIS requirements.
- Electronic capture of the medical record data from a provider's electronic medical record (EMR) system or an aggregator partner (HIE/HIOs).
- Using a variety of connectivity mechanisms to send C-CDA’s to a health plan’s secure endpoint and deliver normalized (CCD) and free-form information to each EMR system.
- Leveraging existing ADT member monitoring and using discharge data as the triggering event to request a patient chart from existing data source partners.