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AaNeelCare® – QM

Quality Management comprises of HEDIS, 5 star rating & PQRS. QM Module caters towards making sure that the quality of practice and services rendered are to the highest level of satisfaction, while reporting the quality measures as and when required.

AaNeelCare® – QM

Quality management comprises of HEDIS, 5 star ranking & PQRS. The main objective of AaNeelCare® – QM is to aid the practice in maintaining good quality of services as well as in reporting those quality measures as and when required of.
By using our AaNeelCare® – QM, practices can be at ease about quality reporting.

HEDIS
The Healthcare Effectiveness Data and Information Set (HEDIS) is a widely used set of performance measures in the managed care industry, developed and maintained by the National Committee for Quality Assurance (NCQA).This can be used by purchasers, physicians and consumers for evaluating and comparing the performance of health plans in promoting the health and well-being of their members.

Health plans are required to report this large set of measures annually. Employers and prospective members can then compare plans on their quality of care.

HEDIS consists of 80 measures across 5 "domains of care". HEDIS data are collected through surveys, medical charts and insurance claims for hospitalizations, medical office visits and procedures.

By using our HEDIS module, all the HEDIS measures can be recorded and also can be customized by choosing the preferred measures according to their health care setting.

For every HEDIS measure, the denominator, the numerator, exclusions, the allowable gap, etc is analyzed and set in a technical way, so that the values can be captured from the backend. This in turn can be run in a report from the module.

Some actions health care providers can take for effectively recording HEDIS measures are:

1. Providing the appropriate care within the designated timeframes
2. Accurately documenting all care in the patient’s medical record
3. Accurately coding all claims
4. By responding to plan’s requests for medical records within 5 business days
5. Allow access to or provide records as requested
6. Keep accurate, legible and complete medical records for their patients
7. Help ensure HEDIS-related preventive screenings, tests and vaccines are performed timely and in an appropriate manner

The HEDIS calendar and deadlines are set each year as follows:
Deadlines Action
Feb - May 15 Clinical Quality Staff collect HEDIS data (Medial Record Reviews)
June Results are reported to NCQA
September NCQA releases Quality Compass results nationwide


Our HEDIS module is built it such a way that it creates reminders, alerts & Notifications taking cues related to the HEDIS measures requirements. As a result, none of the HEDIS measures requirement criteria is missed or goes unnoticed.
5 Star Ranking
5 Star Ranking is introduced as part of an effort to help educate consumers on quality and make quality data more transparent. The ratings comprises of over 50 measures from 5 different rating systems. They are:

HEDIS (Healthcare Effectiveness Data and Information Set)

CAHPS (Consumer Assessment of Healthcare Providers and Systems)

CMS (Centers for Medicare and Medicaid Services)

HOS (Health Outcomes Survey)

IRE (Independent Review Entity)

Based on the technical specifications given by CMS, rates and scores are calculated and stars are graded on a contract level. CMS Stars ratings are published annually and are available for all Medicare members. Plan members use the star ratings as a way to compare performance among several plans when choosing their enrollment. Ratings range from 1 to 5 stars, with five being the highest and one being the lowest score. Medicare reviews plan performances each year and releases new star ratings each fall which means plan ratings change from one year to the next.

Plans are rated on how well they perform in 5 different categories:

1. Staying healthy: screenings, tests, and vaccines

2. Managing chronic (long‑term) conditions

3. Member experience with the health plan

4. Member complaints, problems getting services, and improvement in the health plan’s performance

5. Health plan customer service

By Using our AaNeelCare® – QM, practices can achieve good star rankings. The criteria, the denominator and numerator, exclusions for each measure is fed into the system. As a result, there would be alerts & notifications indicating there is a criteria that has to be met to fulfill any measure.
PQRS (Formerly known as PQRI)
PQRI is a voluntary physician quality reporting program that has an incentive payment for Eligible Professionals who successfully submit report on quality measures for covered Physician fee Schedule (FPS) services provided through Medicare Part B fee-for-Service (FFS) beneficiaries.

With AaNeelCare® QM, a physician can do PQRI successfully with ease. To qualify for the incentives, at least three Physician Quality reporting System MyHealth EHR measures must be met at an 80 percent reporting rate.

The PQRS program provides a financial incentive to eligible professionals for voluntarily reporting data on specific quality measures applied to the Medicare population. PQRS program requirements and measurement specifications change each year.

By using AaNeelCare® - QM, physician groups can go on to receive extra income from incentives that can be used in further improving their practices.

Examples of some measures are:
Falls: Risk Assessment (#154)
Medication Reconciliation: Reconciliation After Discharge from an Inpatient Facility (#46)
Preventive Care and Screening: Advising Smokers to Quit (#115)
Health Information Technology (HIT): Adoption/Use of Electronic Health Records (EHR) (#124)
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up (#128)
Documentation and Verification of Current Medications in the Medical Record (#130)
Pain Assessment Prior to Initiation of Patient Treatment and Follow-Up (#131)

Testimonial

AaNeelCare® is very as customized and individualized. They analyze and assess our needs before presenting us with the required modules for our setting. Depending on for what healthcare environment do you need this technology, whether it is a physician office using only EMR or a hospital, and then they customize the product to those needs. They also scale the requirements as per our demands as we grow. AaNeelCare® provided us with all the things we were looking for. They had the modules, they had the integration, they had the right technology, and they were the kind of company we liked working with. Their customer support is awesome.

AaNeelCare® is very user friendly. You are able to move from one screen to another quickly. There is no much clicking required as in other EHRs , we’ve worked with.

The functionality of this product is excellent. It provides efficiency and is user friendly. It is well-designed to capture the modern technology we use today.

This software is user-friendly enough for each person in your office, even for the not so computer savvy users! Most of the modules are simple and easy to use, all the icons are simple to navigate and make life easier.

AaNeelCare® has been absolutely a pleasure to work with. We could not have moved as quickly as we have without AaNeelCare®’s constant support and monitoring of our progress as we implemented this product.

I'd highly recommend AaNeelCare® to Physicians and hospitals for this allows complete and precise maintenance of patient records, saving lots of time and money. The software not only helps in management but also in improving the quality of medical practices and processes as it reduces manual errors.

Thank you all, for an absolutely fantastic product that meets all our needs under one roof that is so incredibly logical and user friendly. I’m so happy that there is something out there that actually works, even when compared to big names in the market. If all my fingers were thumbs I would give 10 thumbs up!