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Brochure: Quality360™- The Next-Generation Integrated HEDIS® Engine & Analytics Platform

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Quality360™ is a high-performance, integrated ecosystem engineered to transform healthcare quality measurement and reporting for health plans. As an NCQA-certified SaaS platform, it combines a HEDIS® Engine, Abstraction, and Data Analytics to simplify complex quality initiatives and accelerate gap closure.

By integrating diverse administrative and clinical data, Quality360™ establishes a single source of truth for quality metrics. This provides a holistic, longitudinal view of member health, enabling health plans to precisely identify care gaps, attribute them to specific providers, and generate actionable cohorts for targeted intervention.

Core Capabilities for Quality Improvement

Quality360™ empowers organizations to scale HEDIS® chart review, hybrid abstraction, and regulatory submissions with a suite of integrated tools.

Accelerated Processing and Reporting

Achieve rapid throughput to meet critical deadlines with optimized data management and efficient reporting. Automated workflows drive measurable operational efficiency, allowing organizations to manage large-scale reviews within tight timeframes.

Integrated Medical Record Review

Modernize the end-to-end review process with a unified platform. Key features include:

  • Seamless compatibility across abstraction tools, reporting, and dashboards.
  • Real-time hybrid reporting that eliminates data lag.
  • Consolidated medical records in one-tool views for efficient abstraction.

Unified HEDIS® Workflow

Unify medical record abstraction, chase management, and reporting within a single, integrated workflow certified for NCQA compliance. This centralized approach is engineered for accuracy, supporting precise measure calculations and ensuring robust audit readiness.

Real-Time Performance Tracking

Track program progress with comprehensive scorecards and chase completion dashboards. These analytics-driven summaries empower teams to monitor performance in real time, rapidly identify gaps, and implement targeted interventions to strengthen HEDIS® performance and optimize measure closure.

Advanced Analytics and Automation

Leverage intelligent automation and predictive insights to drive higher success rates and enhance data integrity.

Feature

Description

Benefit for Health Plans

Predictive & Comparative Analytics

High-impact analytics anticipate quality trends and benchmark performance against industry standards.

Supports data-driven, forward-looking decision-making to stay ahead of market changes.

Intelligent Chase Management

Highly configurable, automated chase rules drive higher retrieval success rates.

Reduces manual touchpoints and accelerates gap closure through dynamic synchronization between chase activity and medical record workflows.

Automated Data Hygiene

An advanced quality rule engine and embedded cleaning tools systematically identify and correct data anomalies.

Enhances data integrity, maximizing performance and ensuring regulatory precision.

Streamlining Regulatory Submissions and Compliance

Quality360™ is built with purpose-built compliance tools to ensure transparent, audit-ready submissions and ongoing alignment with regulatory standards. Explore more about our comprehensive solutions for Risk Adjustment & Quality.

  • Flexible Sampling Methodologies: Deploy customizable sampling configurations, including reuse and prior-year logic, tailored to each organization’s specific needs for precise and compliant sampling.
  • Streamlined Hybrid Abstraction: Empower end-users with intuitive hybrid abstraction tools that integrate real-time reporting and dashboards, eliminating latency and ensuring full visibility at every stage.
  • Seamless Submissions: Simplify reporting through automated features built for HEDIS audit and submission compliance. Workflows are transparent and straightforward to support end-to-end accountability.
  • Comprehensive Regulatory Reporting: Achieve regulatory excellence with native support for IDSS, PLD, MLD, and custom regulatory reporting formats.

Proven Performance Metrics and ROI

Quality360™ delivers measurable return on investment and substantial improvements in quality ratings.

 

Metric

Result

Retrieval Rate

95%+ across client base

Stars Improvement

28% improvement for MY2024

Medical Record Review Validation

100% pass rate

Hybrid Measure Rate Improvement

77%+ year-over-year

Retrospective Submissions

Zero audit issues

Value-Based Program Support

Increased support for Stars and Quality Withhold (MMP) programs