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HealthEdge® Achieves NCQA HEDIS® Allowable Adjustment Certification, Setting New Standard for Quality in Health Plan Care Management
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HealthEdge®, a leader in next-generation health management solutions, achieved its 5th consecutive NCQA HEDIS® Allowable Adjustment (AA) certification for a select group of measures for Measurement Year 2024. This certification underscores HealthEdge's commitment to its GuidingCare® customers by empowering them to effectively assess and enhance the quality of care and services delivered to their members.
The National Committee for Quality Assurance (NCQA) is an independent accrediting body that champions healthcare excellence by evaluating the quality of care and services provided throughout the healthcare industry. The Healthcare Effectiveness Data and Information Set (HEDIS) is one of health care’s most widely used performance improvement tools, used by the nation’s health plans to evaluate their performance in terms of clinical quality and customer service.
The NCQA Measure Certification program rigorously validates each organization’s quality measure logic, ensuring that health plans produce accurate results. The NCQA Measure Certification program is pivotal for entities relying on quality measurement data to make informed decisions regarding quality reporting and value-based contracting.
"Achieving this certification again this year is a renewed promise to our customers and their members that we are dedicated to providing solutions that are both innovative and reliable," said Dr. Sandhya Gardner, General Manager, Care Solutions and Chief Medical Officer. "Health plans can depend on us to deliver data that helps them meet regulatory requirements and influences positive changes in their quality improvement programs."
With these measures, GuidingCare enables care managers to efficiently identify members who have not met critical preventive care standards, such as vaccinations for children under age two or mammograms for women ages 40 to 74. This capability not only makes it easier to pinpoint gaps in care, but also allows care managers to provide targeted support, helping members overcome barriers and ensuring access to necessary healthcare services. GuidingCare supports clients’ value-based care initiatives by providing an interoperable care management solution which results in improved health outcomes and a more seamless care experience.
The benefits of NCQA Measure Certification extend beyond compliance and offer health plans additional operational efficiencies. It streamlines quality reporting by incorporating new HEDIS measures into the testing process, demonstrates accuracy and data integrity, reduces administrative burdens on health plans, and allows HealthEdge to act as a trusted partner, committed to innovating a world where healthcare can focus on people.
"We are proud of this achievement and look forward to expanding our NCQA certified HEDIS measures in the coming years. We value NCQA’s commitment to digital quality innovation and look forward to supporting health payers and other clients in this patient-centered digital transformation," added Gardner. “As the healthcare industry leans into understanding more about Social Determinants of Health and the impact they have on health outcomes, we strive to continuously ensure our clients excel in providing equitable quality care, with better value and fewer barriers."
About HealthEdge:
HealthEdge® is building a future without limits for health plans, where they can deliver better service and care, make more informed decisions and streamline operations. Through an integrated platform of solutions for core administration (HealthRules® Payer), payment accuracy (HealthEdge Source™), care management (GuidingCare®) and member experience (Wellframe™), health plans can converge their data and harness automation to drive more informed decisions, improve touchless transaction processing and payment accuracy, foster meaningful collaboration and enhance service and care delivery. HealthEdge is trusted by over 130 health plans, covering more than 81 million lives across 48 states. See what it means to converge without limits at HealthEdge.com and follow us on LinkedIn.
About NCQA
NCQA is a private, nonprofit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care. In recognition for its leadership in diversity, equity and inclusion, NCQA has won the Excellence in Diversity Award from the Chesapeake Human Resources Association. NCQA’s website (ncqa.org) contains information to help consumers, employers and others make more-informed health care choices. NCQA can be found online at ncqa.org, on Twitter @ncqa, and on LinkedIn at linkedin.com/company/ncqa.
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