Primary Care Quality Support Service
What We Do
Quality Health Partners supports primary care physicians achieve 5-star quality ratings by placing a clinical quality team in provider practices for the sole purpose of taking care of the administrative, documentation, and coding requirements to close quality gaps in care, capture Hierarchical Condition Categories (HCCs), and completing the Annual Wellness Visit for their patients.
Pillars of Excellence
We believe most primary care physicians are excellent doctors and realize their quality of care ratings may not reflect the work they do to keep their patients healthy. We understand that there are reasons beyond their control that can impact their quality scores and we have a model that focuses on demonstrating the hard work and quality outcomes primary care physicians achieve by giving health plans and medical groups what they need to measure quality and risk. Our goal is to give time back to independent primary care physicians so they can have a healthy work-life balance while maintaining their practice.
ANNUAL WELLNESS VISIT (AWV)
Preparing for a patient’s AWV takes time and resources. The AWV is the best way to document and code what is needed to achieve high-quality results and capturing HCCs. Our PCP Triple Win model benefits the doctor, patient, and payer. We do the work so all three win.
From scheduling the AWV appointment to completion of the AWV, we take care of all the details that can take hours of your staff’s time. This allows our doctor partners to spend more time with their patients and less time with payer administrative requirements.
CLINICAL DOCUMENTATION & CODING
Clinical documentation is at the core of every patient encounter. In order to be meaningful it must be accurate, timely, and reflect the scope of services provided. Because HCC coding for risk adjustment requires providers to document thoroughly all chronic disease processes and manifestations in the patient’s medical record, our Clinical Quality Team has clear understanding of guidelines, regulations, diagnosis coding, and risk adjustment.
From scheduling the AWV appointment to completion of the AWV, we take care of all the details that can take hours of your staff’s time. This allows our doctor partners to spend more time with their patients and less time with payer administrative requirements.
CLINICAL QUALITY TEAM
Our Clinical Quality Team is comprised of specially trained licensed nurse practitioners, physician assistants, quality coordinator medical assistants, and triple certified coders (Certified Professional Coder (CPC®), Certified Outpatient Coding (COC™), and Certified Risk Adjustment Coder (CRC™).
Our only focus is the Annual Wellness Visit, HCC capture and documentation, and closing quality gaps in care. Our team is efficient and effective in achieving exceptional results for our provider partners.
It is important that our team embodies your practice culture. We blend in as part of your practice, will care for your patients with respect and dignity. Whether it is short-term or long term, we hope you will find us to be your friend and trusted partner. Our team selection process is not complete until our primary care partners agree to the team we have selected for their practice.
QUALITY IMPROVEMENT MEASURES
Our quality team is focused on Five-Star Quality Rating System created by the Centers for Medicare & Medicaid Services (CMS). Our PCP Triple Win model incorporates measures set forth by HEDIS, Align. Measure. Perform. (AMP), the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys, and The Health Outcomes Survey (HOS).
From coding and billing the right codes and targeting the right patients to close gaps, we aim for 5-Stars so our provider partners can reap the benefits, whether, in quality bonus incentives, or public scorecard ratings, our goal is to make our PCPs shine.
HEALTH PLAN & MEDICAL GROUP/IPA COLLABORATION
Our team gathers and prepares the patient chart from the health plan and medical group/IPA sources. We do the administrative work of logging into different plan or group provider portals for target lists, complete plan or group-specific patient assessment forms, make necessary referrals to close gaps in care, and attest to quality measures. We also reconcile PCP quality scores with the plan or group to ensure they are reflective of the work completed.