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Quality Improvement
QUALITY IMPROVEMENT MATERIALS
Quality
CAHPS Tip Sheets
Improving Medicare Patient-Reported Outcomes
Medicare Member Rewards Program
Provider Manual
Provider Tools to Support Quality
Quality Incentive Program
Quality Measure Resource Guide
Risk Adjustment/Learning Online Veradigm
See What We Are Telling Our Members About Quality
Skilled Nursing Facility Quality Guide
Social Determinants of Health (SDOH)
Supplemental Data Training PowerPoint
Telehealth
Adult Comprehensive Health Assessment Provider Incentive Program
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Quality
Our Quality Improvement programs and information are developed, implemented, and evaluated to promote and preserve clinical excellence that fosters the safety and well-being of our members.
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At EmblemHealth, we feel so strongly about quality improvement that we have developed several different quality incentive programs designed to meet providers where they are today, making it easier to meet program participation requirements. Also, our risk adjustment program offers incentives for primary care providers for correct coding and billing practices for their EmblemHealth members enrolled in New York State of Health (NYSOH) Marketplace, Medicare HMO, and Medicaid. See below for program qualifications and specifications that might fit your practice.
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The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey helps us gain a better understanding of our members’ experiences when using their health care benefits so we can drive continuous improvement. Your interaction with our members has a direct impact on their response to the CAHPS survey. Please access the documents to get further insight regarding CAHPS (including survey questions) and tips to ensure you provide the best care to your patients.
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The Medicare Health Outcomes Survey (HOS) provides a standardized understanding of patient outcomes around physical and mental health, fall risk and prevention, physical activity, and urinary incontinence. Our providers have a direct impact on patients’ perception of their health and quality of life. The tip sheet linked below offers techniques that may help providers enhance their Medicare patients’ health care outcomes.
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The EmblemHealth Member Rewards Program gives members opportunities to be rewarded for taking good care of their health. Members who join the program can earn rewards for getting needed medical care such as their annual wellness visit, selected preventive screenings and more.
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Quality Incentive Program Booklet
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EmblemHealth is committed to helping our members stay healthy, get well, and live better lives. Our provider network plays an integral role in this effort, and we know you share the same commitment to delivering excellent care to your patients. As part of the EmblemHealth provider network, you have an opportunity to earn incentive payments for the work you do. Our Quality Incentive Program (QIP) will continue to focus on measures that impact and improve important health outcomes for members. See attached pdf for specific program parameters and comprehensive information.
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The 2023 Quality Measure Resource Guide provides a brief overview of national and state quality measures* that evaluate various domains of preventive, acute, and chronic care. We hope that you find this guide useful for the care of our shared members.
*Measures included in the guide are sourced from National Committee for Quality Assurance (NCQA) www.ncqa.org, Centers for Medicare & Medicaid Services (CMS) https://www.cms.gov, and New York State Department of Health (NYSDOH) www.health.ny.gov.
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EmblemHealth’s primary concern is the quality of care our members receive in every setting, including skilled nursing facilities (SNFs). To aid members, families, and providers in the decision of choosing a SNF to meet their/their patient’s needs, EmblemHealth has compiled a list of our contracted SNFs with a Star Quality Rating of 3 and above.
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We encourage you to provide EmblemHealth access to your patients’ medical records, supply supplemental data, and share nonstandard data to ensure we capture all needed information regarding your patients. You must provide EmblemHealth with access to medical records, at no charge, for quality reviews related to the Quality Incentive Program (QIP), as well as for Healthcare Effectiveness Data and Information Set (HEDISR) and other regulatory initiatives.
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Telehealth uses technology to deliver cost-effective, convenient, high-quality care to ensure patients receive the right care, at the right place, and the right time. But did you know that telehealth can be leveraged to address gaps in care, maximize incentives and obtain the data needed for commercial, Medicaid, and Medicare health plan risk adjustment programs and value-based contract performance?
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Adult Comprehensive Health Assessment Provider Incentive Program
EmblemHealth is pleased to announce a new incentive opportunity for providers who do not participate in other EmblemHealth value-based arrangements. The new Adult Comprehensive Assessment Provider Incentive Program offers a unique opportunity to help close your patients’ gaps in care while increasing your revenue and meeting your important quality benchmarks. If you meet this criteria, join us in making the commitment to help our members stay healthy, get well, and lead better lives.
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Adult Comprehensive Health Assessment Form
Social Determinants of Health (SDOH)
Social Determinants of Health (SDOH) are the non-medical factors that influence health outcomes. Addressing the environmental, geographical, occupational, educational, and nutritional needs of patients requires coordination and alignment amongst providers, payers, and the community at large. Read our "Guide to SDOH for Providers" to learn more.