Quality Support Solutions

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 support solution. By replacing costly, manual workflows with standards-based connectivity and data formats, we are able to remove provider abrasion, optimize cost, and leverage data. This translates into better scores, better reimbursement, and more incentives.

Exchanging clinical information for quality programs and value-based care has always been a labor-intensive, manual process resulting in missed care opportunities, unnecessary costs, and friction between payors and providers. However, with our experience in the clinical data exchange space supporting complex use cases and bi-directional exchange through nationwide alerting and chart retrieval, we are uniquely positioned to assist healthcare entities with new Star and HEDIS requirements.

These new requirements call for payors to retrieve and transmit clinical information about their members to providers in their network. For example, measures call for primary care providers (PCPs) to be notified of their patient's discharge within 48 hours, follow-up after emergency room visits for patients with two or more chronic conditions, and assess the rate of unplanned acute readmission after discharge.

We are able to capture the medical record data from a provider's electronic medical record (EMR) system or from an aggregator partner (HIE/HIOs) using a variety of connectivity mechanisms and send C-CDA’s to a health plans’ secure endpoint and deliver normalized (CCD) and free-form information by leveraging each EMR system’s capability.  Centauri can accommodate existing workflows and send information directly to internal and external coding teams.

We are able to take advantage of existing ADT member monitoring and use the discharge as the triggering event to request a patient chart from existing data source partners.  This data is delivered to both the health plan’s enterprise platform and directly to the provider workflow in the EMR, satisfying the provider’s need to receive relevant clinical information in a non-disruptive manner.

 

Key Differentiators

  • Leverages established flows for monitoring admission/discharge data, querying for patient charts and integrating into the health plan enterprise systems
  • Delivers data seamlessly into current provider workflows
  • Results in no provider abrasion
  • Aligns with Enterprise Interoperability Goals