Commercial Payer Quality & Incentive Programs Commercial payers increasingly tie reimbursement to quality performance rather than volume — through pay-for-performance arrangements, quality attestations, and incentive programs layered on top of your existing contracts. We track what each payer requires, manage attestations, and help you capture the incentive dollars already built into your contracts.
Medicaid Managed Care Quality Reporting States contracting with Medicaid MCOs, PIHPs, or PAHPs are federally required to have an External Quality Review Organization (EQRO) evaluate those plans every year against the CMS Child and Adult Core Set measures, with results published in a public Annual Technical Report. If you're an MCO, a delegated provider group, or a vendor supporting one, we help you prepare for and perform well under that review — from performance measure validation to the compliance review states run on a three-year cycle.
HEDIS Compliance & Care Gap Closure HEDIS scores drive both commercial Star Ratings and Medicaid plan performance — and directly affect the incentive and withhold dollars tied to them. We help identify open care gaps, prioritize which measures move the needle most, and build a closure plan your care team can actually execute before measurement periods close.
State-Specific Quality Improvement Program Navigation Every state runs its Medicaid quality program a little differently — different Core Set measure selections, different withhold arrangements, different reporting cadences. We translate your specific state's requirements into a plan built around your organization's structure, so you're not guessing at what applies to you.
