MercyCare Health Plans taps cloud-based AI tool for HEDIS compliance

MercyCare Health Plans will deploy a cloud-based solution to streamline its Healthcare Effectiveness Data and Information Set (HEDIS) submissions.

MercyCare has signed a multi-year agreement with Newport Beach, Calif.-based Vital Data Technology to make Affinitē Quality’s real-time quality analytics, which are provided by measure and member, the companies said.

According to Vital, some of the top challenges health plans face include identifying, stratifying and prioritizing members; using applied data science techniques to systematically segment members by specific criteria, enabling actionable, timely interventions; and managing and tracking how well providers are performing to quality measures year-round. The company contends that these challenges can be solved by using Affinitē Quality’s artificial intelligence, risk algorithms and quality metrics that stratify and prioritize care interventions for members.

MercyCare—a wholly owned subsidiary of Mercyhealth based in Janesville, Wis., serving 40,000 members located throughout southern Wisconsin and northern Illinois—joins other organizations nationwide seeking to leverage Affinitē's integrated advanced analytics and algorithms embedded with HEDIS measures, the companies said.

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Filipino care worker John Denmark Pineda assists an elderly resident at Eisei hospital in Tokyo, Japan, on Monday, Dec. 6, 2016. Strict regulations mean that only about 2,600 nurses and caregivers from Southeast Asia are working in Japan. Pineda, now married to a Japanese citizen and aiming to pass the country's notoriously difficult nursing qualification, said that migrant workers should be allowed to play a bigger role. Photographer: Akio Kon/Bloomberg

“Affinitē Quality gives us timely and profound insight into our members' quality status,” says April Hays, director of compliance and quality and audit privacy officer for MercyCare. “The solution is thorough and intuitive, eliminating tedious data rework year-over-year—making the whole process much faster and more effective."

Vital Data Technology's Affinitē Quality solution, part of the Affinitē platform, accelerates quality improvement efforts by aggregating every measure into a single quality scorecard that has drill-down capabilities for displaying measure performance, according to Vital Data Technology. The solution drives workflow efficiencies and data accuracy through multi-level administrative control, year-round medical record abstraction and review, and alleviates error-prone workload increases during HEDIS submission season.

“Our goal at Vital Data Technology is to help health plan leaders better leverage their data in this new era of healthcare,” says Matt D'Ambrosia, CEO of Vital Data Technology. "Health plans like MercyCare are great client partners for us, because they value innovation and collaboration as we take HEDIS from an after-the-fact measurement of the quality process, to a quality improvement solution that benefits the plan and their members year-round."

Vital Data Technology’s partners include Medicare, Medicaid, commercial and self-funded adult and pediatric populations nationwide.

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