MEET CMS HEDIS 5-STAR RATING

With Pure4 HEDIS Campaign Management Process

Tampa, FL. June 14th, 2022.

Diabetic retinopathy is a leading cause of preventable vision impairment and blindness in the US/World. It occurs in about a third of people with diabetes and its damaging effects on vision can be prevented by early detection and treatment through screening. Vision impairment and blindness have major economic consequences in terms of use of health and social care resources and impact on economic productivity (WHO, 2019). Diabetic retinopathy mainly is caused by the effect of raised blood glucose on the blood vessels in the retina. It can be prevented, and its progression slowed, by control of blood glucose, blood pressure and elevated lipids. If it progresses to an advanced form, treatment with laser and, if available, intraocular drug injections can prevent vision impairment and blindness. Diabetic retinopathy screening can identify early changes in the retina so treatment can be given before vision impairment or blindness occurs.

Although Center for Medicare and Medicaid Services (CMS) offers incentives to insurance companies to meet screening targets under HEDIS program and most insurance companies have some form of eye checks campaign in place for people with diabetes, these campaigns are often not adequately resourced or organized systematically as a screening pathway. For that reason, many people with diabetes are living with preventable vision impairment and blindness.

Case Study

Constellation4 Health has successfully deployed the technology at Argus Dental & Vision for multiple health plans.
30K+ our technology is used in completing screening for 30k+ patients in year 2021

5-Star multiple health plans have met CMS 5-star ratings which requires 78% of the eligible population to be screened

Payer Impact

the payers for completing CMS screening targets.

the conditions without detection and treatment.

Provider/ PCP Impact

claims.

QIP (payfor-performance program) measurement set which is aligned with HEDIS. Compliance with HEDIS measures would help increase QIP score.

Solution

Constellation4 with a mission to improve patient health has built a campaign management solution for HEDIS quality Managers to deploy a screening pathway and meet their annual CMS HEDIS targets. Our Pure4 Solution has below capabilities to run and manage the campaign.

Step 1: Identification

sent for at home screening by geographic area.

Step 2: Invitation & Information

Step 3: Testing & Reach Out

Step 4: Scorecard

Step 5: Continuous Improvement

the screening program.

Case Study

Health Plan Open Gaps

10,070

Rate %

66.96%

Gaps To CMS %-Star Goals

3,365

20,409

Completed Exams

How To Get Started

The tool is customizable as per the need of the HEDIS coordinators and seamlessly integrates with variety of claims systems. Contact us to schedule a call to see how the tool can help you organize campaigns and beat your screening targets! Email us or go to contact us online.

Author
Gold circle of founder and ceo Saru Seshadri

Saru Seshadri

Founder & CEO

Sachin Sumant VP of Data Science & Analytics

Sachin Sumant

VP of Data Science & Analytics

About Constellation4 Health

Constellation4 Health is a Healthcare technology company providing innovative and scalable solutions for leading Health Insurance Payers and Providers. Solutions include:

Healthcare Analytics

Automate and mature your Data Science, Predictive Analytics and AI. We have over 100 Use Cases including claims reconciliation, profitability analysis, and HEDIS Campaign Management.

Provider Data Management

A single source of truth for provider data powered by a Data as a Service platform that ensure 92% data accuracy compared to an industry standard of 52%.

Provider Network Management

Reimagining the workflows between payers and providers is a must to create sustainable payer models. A complete contact to contract platform powered by Salesforce.

Referral Care Coordination

Our seamless physician to physician referral platforms grows market share, prevents leakage and enables providers to have complete visibility on patient status.

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