Enhancing Quality Measures in Healthcare Using Digital Tools

We recently hosted a webinar “Enhancing Quality Measures in Healthcare Through Digital Engagement” focused on how digital tools and technologies can transform quality scores in healthcare. Featuring Angela Perri, Chief Medicare Officer at UPMC Health Plan and Ryan Stalvey, Director of Member Engagement Strategies at Prospect Medical and facilitated by Relay’s SVP of Healthcare, Dan Sweeney, the engaging dialogue touched on a number of topics including:

In this blog post, we will dive into these topics and the conversations that they sparked between our panelists, but if you are interested in watching the entire webinar, click the link here.

Kicking off the conversation, Dan asked Angela and Ryan about how quality measures, particularly Star Ratings, impact financial and operational aspects of their organizations. Angela shared, “it’s not only important from a reputation perspective, but it gives us a barometer for which we can really determine how well we’re doing based on the government’s measurement. It’s an important component both financially and from a reputation and overall quality perspective.” Ryan emphasized the financial impact that Star Ratings have and how the different domains like CAHPS, HEDIS, and pharmacy measures each play a role in both Star Ratings and incentive programs, so, as a provider, it’s important to understand those domains as well.

Angela also shared some important insights on the evolution of the Medicare model and Star Ratings: “CMS is expecting all Medicare beneficiaries to be in a value-based model by 2030. They’re also making changes to the Stars program almost every year and what the expectations are. The last couple years, member experience has been close to almost 60% of your Star rating and score. From a policy perspective, saying ‘experiences’ is widely variable as part of that, and HEDIS measures, pharmacy measures, it needs to be a little more in balance. So, for 2027, now that pendulum is swinging back.”

With these changes in mind, plans and providers have begun to shift their approach to meet the new guidelines. One way that they are getting ahead of things is around the member’s annual wellness visit. Angela shared, “the annual wellness visit is an example that CMS put into place a while ago to create more of a value model than a volume model with physicians. The idea is to have a little more time with the member to do a comprehensive evaluation, to actually understand what’s going on with them, and put a plan of care in place over time.” Ryan and his team at Prospect Medical have already prioritized that experience for members and are using their digital tool, Relay, to drive annual wellness visits. “One of the things that we use Relay for member engagement, one of our flagship messages is to help the member schedule annual wellness visits. That’s one of our big priorities. Getting members in because it’s not a simple visit, right? It’s 45 minutes to an hour long, and that helps experience.” This is an example of how leveraging digital tools can have a tangible impact on the improvement of quality measures.

Ryan elaborated further about the other benefits to using digital tools for this type of engagement. “From a digital perspective, from member engagement perspective, we are helping our providers to where their staff doesn’t have to call members to schedule them, although they can. We use the technology to proactively have them call our call center, we’ll schedule the appointment depending on the region, a couple different nuances there, but access to care and annual wellness visit is paramount.”

The use of digital tools is becoming even more relevant now given the NCQA’s move towards digital quality measurement, allowing for more accurate, real-time information sharing. Angela also shared that, like Ryan, UPMC has successfully implemented digital tools enhance their quality measures. Proactively reminding members about preventive screenings and opportunities to close care gaps, using digital tools, roll up to important HEDIS measures that can then improve overall quality scores. Angela noted, “So the best way, I think, to raise some of those scores is to understand those pain points and then lean into either a digital solution for those that need it, but also creating access for those that want to come in from a brick and mortar perspective too.” Balancing the need for human interaction with the desire to use digital tools at these moments is certainly important to consider for both plans and providers.

However, in terms of driving speed to care and creating better access and experience for members, digital wins every time. Ryan shared, “where Relay has helped is we’ve designed a text message campaign that proactively same day, pushes out all approved referrals to our patients. That gives them not only the perception of access, but that gives them the ability to schedule an appointment right then and there from that text message to the specialist.” By delivering this message digitally rather than the alternative, which would be direct mail, a provider like Prospect Medical, can reduce the time to referral significantly, creating a much better experience for the patient. Similarly, Angela highlighted the desire that her Medicare members have for digital: “I want to be able to do things from my phone or digitally. And many people aging into Medicare feel that way. They want to do televisits. They want to do things digitally. They want to get their answers in more of a digital modality.”

Lastly, there was mention of how digital tools can help with health equity. Angela said, “One of the areas where digital can be very useful is thinking about how we can drive equity differently, and that includes people with English as a second language. The lengths of stay in hospitals for people who have English as a second language is usually double. And it’s all about communication. So where digital tools can be particularly useful for physicians as well as plans is in helping to bridge those barriers.” By leveraging digital tools, plans can support people in their health journey and enable equity across the board. Ryan shared a concrete example of how they use their digital tool, Relay, to bridge that gap, “We also use Relay in different languages. So, when we do text members, if they have their language, their proper written language filed with the health plan, we send texts in Spanish in Vietnamese, and to address hospital stays, one of the campaigns that we have with Relay is a post-discharge follow up, or after they leave the emergency room, we get that set of data and instantly engage with them, whether it’s scheduling an appointment with their PCP to close a care gap or just to check in with the member.” This is just another way that digital can improve plan and providers outreach and engagement a more meaningful and impactful way.

The fact of the matter is, digital has become the preference, by and large, for people to consume information, so it’s no surprise that using digital tools can have such a profound impact on quality measures. As part of her final comments Angela shared, “there’s an appetite to be able to get information quickly. We are a culture that likes information instantly and are not very patient when it comes to the inability to get at that. And digital enables quite a lot. So I do think you have to be selective in what that looks like, but it has to be a central piece of what you do and not an ad hoc thing. It has to be core to how you operate overall.”

Tune into the entire webinar conversation here.

If you are interested in learning more about Relay and the Relay Feed, reach out to sales@relaynetwork.com

If you would like to experience a Relay Member Feed for yourself, click here.