HealthEdge® Secures NCQA HEDIS® Certification, Elevating Care Quality

HealthEdge® Achieves NCQA HEDIS® Allowable Adjustment Certification

BURLINGTON, Mass. – HealthEdge®, a leader in innovative health management solutions, has successfully attained its fifth consecutive NCQA HEDIS® Allowable Adjustment (AA) certification. This recognition is granted for select measures pertinent to the Measurement Year 2024. This accomplishment reinforces HealthEdge's unwavering dedication to its GuidingCare® customers, empowering them to effectively evaluate and improve the quality of care and services provided to their members.

Understanding NCQA and HEDIS

The National Committee for Quality Assurance (NCQA) is a renowned independent body that champions healthcare excellence. It evaluates healthcare quality across the industry by utilizing the Healthcare Effectiveness Data and Information Set (HEDIS), which is widely used by health plans nationwide to assess their performance regarding clinical quality and customer service.

Importance of NCQA Measure Certification

The NCQA Measure Certification program is essential as it stringently validates the quality measure logic used by organizations. This scrutiny ensures health plans provide precise results, which are crucial for informed decision-making regarding quality reporting and value-based contracting.

HealthEdge's Commitment to Quality Care

Dr. Sandhya Gardner, General Manager of Care Solutions and Chief Medical Officer, expressed, "This year’s certification reaffirms our commitment to our customers and their members by ensuring we deliver innovative and reliable solutions. Health plans can rely on our data to meet regulatory requirements and to effect positive changes in their quality improvement strategies."

Enhancing Preventive Care Through GuidingCare

GuidingCare® empowers care managers to efficiently identify members who have not met essential preventive care standards, such as timely vaccinations for children and mammograms for women. This not only enables the identification of care gaps but also facilitates targeted support for members, ensuring access to essential healthcare services. HealthEdge's solutions support value-based care initiatives by providing interoperable care management systems, ensuring improved health outcomes and a seamless care experience.

Operational Benefits of NCQA Certification

The operational efficiencies gained from NCQA Measure Certification go beyond compliance. It simplifies quality reporting by integrating new HEDIS measures into the testing protocol, which demonstrates data accuracy and integrity. This reduces the administrative load on health plans, allowing HealthEdge to maintain its role as a trusted partner in fostering a healthcare system focused on people.

Future Developments and Innovations

Gardner added, "We are proud of this achievement and are keen to expand our certified HEDIS measures in the future. We appreciate NCQA’s commitment to digital quality innovation and are excited to assist health payers and other clients in their transformation towards patient-centered care. As the healthcare industry continues to explore the implications of Social Determinants of Health on outcomes, we remain focused on helping our clients deliver equitable quality care with improved value and reduced barriers."

About HealthEdge

HealthEdge® is committed to building a limitless future for health plans, enhancing their ability to deliver superior services and care, make informed decisions, and optimize operations. Through a cohesive platform that includes solutions for core administration, payment integrity, care management, and member experience, HealthEdge enables clients to align their data and leverage automation. This ultimately facilitates informed decision-making and improves transaction processes, collaboration, and care delivery. With over 130 trusted health plans, HealthEdge covers more than 81 million lives across numerous states. Explore the possibilities at HealthEdge.com and connect with us on LinkedIn.

About NCQA

NCQA is a private, nonprofit organization dedicated to enhancing healthcare quality. It accredits and certifies a broad spectrum of healthcare organizations and recognizes clinicians for excellence in performance. Known for its leadership in diversity and inclusion, NCQA's Healthcare Effectiveness Data and Information Set (HEDIS®) remains the predominant performance measurement instrument in the healthcare sector.

Frequently Asked Questions

What does NCQA certification signify for HealthEdge®?

NCQA certification indicates that HealthEdge® has met rigorous standards in healthcare quality, reaffirming its commitment to excellence in health management solutions.

What is HEDIS and why is it important?

HEDIS (Healthcare Effectiveness Data and Information Set) is a standardized tool used to measure the performance of health plans in clinical quality and customer service, impacting their operational efficiencies.

How does GuidingCare® assist health plans?

GuidingCare® helps care managers identify members who have not met critical preventive standards, ensuring timely interventions and improving health outcomes.

How does NCQA Measure Certification improve operational efficiencies?

The certification streamlines quality reporting, reduces administrative burdens, and enhances data accuracy, allowing health plans to operate more effectively.

What future innovations can we expect from HealthEdge®?

HealthEdge® aims to expand its certified measures, enhance digital quality innovations, and continue supporting health payers in providing patient-centric care.

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