QUALITY IMPROVEMENT MATERIALS

Quality

Adult Comprehensive Health Assessment Provider Incentive Program

CAHPS

Incentive Programs for Providers

Provider Manual

Provider Tools to Support Quality

Quality Measure Resource Guide

Risk Adjustment/Learning Online Pulse8™

See What We Are Telling Our Members About Quality

Skilled Nursing Facility Quality Guide

Telehealth

 

Quality

Quality Drives Everything We Do at EmblemHealth

  • 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. 

  • 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.

 

Adult Comprehensive Health Assessment Provider Incentive Program

  • 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.

  • Adult Comprehensive Health Assessment Form

 

CAHPS

  • The CAHPS survey helps us gain a better understanding of our members’ experiences when using their health care benefits so we can drive continuous improvement. The data collected from CAHPS helps us track and trend results year-to-year, giving us the opportunity to proactively plan and target key areas for improvement. CAHPS also provides a standardized comparison between health plans so that consumers may make informed decisions when selecting providers and health plans.

 

Incentive Programs for Providers

Quality Incentive Program

  • Quality Incentive Program Booklet

  • Providers* who meet these criteria may enroll in the Quality Incentive Program:

    1.    Open Panel: to participate, you must accept new membership.

    2.   Providers at the Group level (indicated as a Med Center by EmblemHealth) must have at least 50 Members in Medicare or Medicaid/ Child Health Plus/HARP or QHP/Essential to be eligible.

    3.    Access to EmblemHealth Provider Portal.

    4.   Medical Record Access and Supplemental Data: you must provide EmblemHealth with access to medical records, at no charge, for quality reviews related to this Quality Incentive Program, as well as for HEDIS® and other regulatory initiatives.

     

    *Primary care providers participate in the Quality Incentive Program at the Group level (indicated as a Med Center by EmblemHealth). Providers participating in a delegated risk arrangement with EmblemHealth are not eligible for the Quality Incentive Program. Additionally, there may be other value-based arrangements that prohibit participation. Please speak to your EmblemHealth Relationship Manager if you have questions about your eligibility for the Quality Incentive Program and existing contracts with EmblemHealth. See attached pdf for specific program parameters and comprehensive information.

 

Provider Manual

  • Provider Manual (Chapter 28 - Quality)

 

Provider Tools to Support Quality

 

Quality Measure Resource Guide

  • The 2022 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.

 

Risk Adjustment/Learning Online Pulse8™

  • Frequently asked questions about Risk Adjustment

  • Connect to EmblemHealth’s Risk Adjustment Partner, Pulse8™ Webinars

 

See What We Are Telling Our Members About Quality

 

Skilled Nursing Facility Quality Guide

  • EmblemHealth’s primary concern is the quality of care our members receive in every setting, including skilled nursing facilities. 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.

 

Telehealth

  • 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?