New Software Program Helps Health Plans Work With Physicians to Lower Costs and Improve Quality, Access.

Tracking medical quality indicators can be a challenge for health plans with large provider networks, but a new release of a software program promises to make the task easier and allow plans to incorporate provider effectiveness as part of future provider payment reforms.

dsthealthsollogo_prodbgDST Health Solutions has announced the general availability of CareAnalyzer Version 3.1. DSTHS CareAnalyzer® helps health plans meet reporting requirements for the Healthcare Effectiveness Data and Information Set (HEDIS) and effectively identify high-risk members for care management. The latest version pf CareAnalyzer is said to also include new provider profiling capabilities that can be used to support pay for performance, identify access issues and detect patient groups receiving lower quality care.

“CareAnalyzer’s provider reporting module allows health plans to evaluate the relative efficiency of primary care providers and to hold providers accountable to quality standards,” said Amy Salls, business solutions director of decision support, DST Health Solutions.

The software’s profiling capabilities are said to be able to identify providers or provider groups that are less effective than their peers at delivering efficient, high quality care. Health plans are also able to detect providers with costly or unusual referral patterns and submit outlier providers for further investigation.

“We expect to see innovative pilot programs which incorporate provider effectiveness as part of future provider payment reform,” Salls added. “This release of CareAnalyzer will allow our customers to provide feedback to physicians, and stimulate voluntary changes in behavior either prior to or concurrent with payment reform.”

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