How health plan quality managers are preparing for 2023

With these impending changes in mind, here are three actions health plans can take in 2022 to improve 2023 performance:

1. Adopt a more comprehensive analytical approach.

Analysis is no longer a myopic, one-dimensional process or concept.

In-depth analysis, or descriptive analysis, can immediately identify positive and negative trends within certain cohorts of members. Meanwhile, predictive analytics offers added value by predicting future performance, such as likely health care behaviors and perceptions, by members.

When used together, health plans take a holistic view of the member experience and can prioritize the right initiatives at the right time for the greatest impact.

2. Deepen root cause analysis.

Membership data from internal processes does not always tell the full story of population health.

Working with a third-party expert to analyze multiple datasets, as well as benchmarking reports, registries, and historical health data, can give health plans a more vivid and detailed picture and help them identify opportunities for improvement. more tangible improvement.

3. Combine disparate data sources to generate actionable predictive models.

To accurately predict future member perceptions and behaviors, such as the likelihood of responding to a CAHPS survey, the likelihood of being very satisfied, or the likelihood of re-enrolling, you need to integrate data from multiple sources and run it in a predictive model.

Key data sets to focus on include:

  • What happened to member: customer service claims, usage, disbursements, or call logs
  • How engaged is the member with their PCP: history of visits and compliance with preventive care
  • Perception of members: survey and benchmarking data
  • Economic and social conditions of members: social determinants of health and census data

The output of the predictive model then becomes a “member engagement blueprint” for leaders to use to create impactful and targeted outreach campaigns to inform, encourage, engage and educate members. Bottom line: The more health plans leverage data-driven decisions now, the better prepared they will be for the upcoming star rating changes in 2023 and 2024.

Find out how Press Ganey is working directly with health plans to address these new challenges and opportunities.

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