By 2030, all baby boomers will be older than 65.1 Since older adults are disproportionately affected by chronic conditions—nearly 80% have 2 or more2—there is a heightened payer focus on chronic disease management and Medicare gap closure.
Recent changes in performance ratings are making it more challenging for payers to achieve the trifecta of effective population health management, profitability, and quality outcomes.
At Quest Diagnostics, we understand the challenges health plans face with closing gaps in care. Our solutions focus on your members as individuals with the goal of meeting them where they are in their health journey. In addition to helping improve member experience and health outcomes, our approach helps support health plan quality measure performance.
Our unique combination of quality lab data, actionable insights, and personalized member services can help your plan
Closing lab-related testing gaps may help improve quality performance scores, such as HEDIS and Medicare Advantage Star measures.
We offer 2 screening models to help you close lab-related testing gaps in a way that best meets the needs of your plan and your members.
Our value-based model takes a data-driven approach that offers the opportunity to test at Quest Patient Service Centers (PSCs) and/or at-home test kits.
At the start of the program, we analyze eligibility files provided by the health plan against existing lab data to
With this model, we only bill when the gap is closed.
Learn how our value-based screening approach helped Oscar Health close gaps in care by making screening easier and more accessible to members.
Our volume-based model takes a fee-for-service approach to closing gaps in care through at-home test kits only.
At the start of the program, we send test kits to entire eligibility file provided by the health plan.
We bill when the test kits are deployed and again when test kits are returned for processing.
From colorectal cancer (CRC) screening to kidney health evaluation for patients with diabetes (KED), we offer an approach that can help you close gaps in care and improve quality performance scores.
Quest Member Insights can provide access to prospective Quest lab test results for your current members and/or historical lab test results for your new members to empower your plan. We help health plans:
Member-based data
Access to comprehensive, prospective member lab test results, including results from hospital stays and other previous payer claims
Claims-based data
A data feed of prospective member lab test results billed to your organization
Historical data
Past lab test results of your current members
Pre-enrollment data
2 years of historical lab test results of your newly enrolled members
Read our analysis on how member-based data can help fill in gaps for quality reporting.
References
1. US Census Bureau. By 2030, all baby boomers will be age 65 or older. December 10, 2019. Accessed September 16, 2024. https://www.census.gov/library/stories/2019/12/by-2030-all-baby-boomers-will-be-age-65-or-older.html
2. National Council on Aging. Get the facts on healthy aging. August 16, 2024. Accessed September 16, 2024. https://www.ncoa.org/article/get-the-facts-on-healthy-aging/
3. Betbeze P. One-star improvement can increase Medicare Advantage revenue by 17%. Health Leaders. May 3, 2018. Accessed August 20, 2019. https://www.healthleadersmedia.com/strategy/one-star-improvement-can-increase-medicare-advantage-revenue-17
4. Bajner R, Meinkow E, Munroe J, et al. The impact of Star ratings on rapidly growing Medicare Advantage market. 2018. Navigant Consulting. February 2018. Accessed September 18, 2024. https://guidehouse.com/-/media/www/site/insights/healthcare/2018/medicare-advantage-analysis.pdf
5. Social determinants of health and Medicare Advantage: Policy recommendations to achieve greater impact on reducing disparities & advancing health equity for America’s Medicare population; 2021. Accessed April 4, 2024. https://ahiporg-production.s3.amazonaws.com/documents/SDOH-MA-IssueBrief-2021.pdf
6. Benavidez GA, Zahnd WE, Hung P, et al. Chronic disease prevalence in the US: Sociodemographic and geographic variations by zip code tabulation area. Prev Chronic Dis. 2024;21:230267. doi:10.5888/pcd21.23026&
7. The Institute for Functional Medicine. Health coaching as a strategy to enhance your practice. November 29, 2023. Accessed October 18, 2024. https://www.ifm.org/news-insights/lifestyle-health-coaching-strategy-enhance-practice
Let’s talk about how we can help you improve quality measure performance, lower costs, and enhance the member experience.
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