Brilliant Care | Quality Management

What our Quality Management entails

Metrics Tracking

We identify all relevant quality measures for your organization – whether it’s blood pressure control rates, diabetes A1c control, cancer screening percentages, patient satisfaction, or hospital readmission rates. We then ensure that our other services (CCM, RPM, AWVs, etc.) are all contributing to improving these metrics. For example, our chronic care and RPM programs directly help improve metrics like BP < 140/90 or A1c < 9 by actively managing those patients (leading to more patients meeting targets). Our AWV efforts help with measures like depression screening or fall risk assessment completion. We essentially overlay a “quality lens” on every activity, asking: how does this drive a measurable improvement?

Closing Care Gaps

A major part of quality improvement is identifying and closing gaps in care– meaning that patients get the care that the quality measures say they should. We have a systematic approach to closing gaps like colon cancer screening, breast cancer screening, eye exams for patients with diabetes, blood pressure follow-ups for patients with hypertension, etc. We covered this in Panel Management, but to emphasize: closing gaps in care is one of the most effective ways to improve quality scores. We use data analytics to find those gaps and then our outreach prowess to fix them, whether that’s nudging patients for labs, sending them reminders for tests, etc.

Data Analytics

We regularly analyze performance data. We’ll provide you with reports showing your baseline on each measure and the improvement trajectory. For instance, maybe baseline colon cancer screening rate was 60%. After 6 months of our efforts, it’s 75%. We’ll give you these concrete numbers. We also help pinpoint any workflow or documentation issues affecting quality. We catch those nuances and correct them (through provider education or process tweaks) because accurate data is crucial. CMS defines quality measures as tools to quantify healthcare processes and outcomes – we ensure those tools (the data) are being captured correctly.

Improvement Initiatives

We adopt a continuous improvement mindset. If a measure is lagging, we dive in and do root cause analysis. Is it patient non-compliance? If so, perhaps group education sessions or new coaching strategies are needed. Is it a documentation gap? Then we adjust workflows. Our team stays current with best practices and guidelines. For instance, if new guidelines emerge for diabetes or hypertension management that could improve outcomes, we integrate that into our protocols. We champion a culture of continuous improvement within your practice, celebrating wins and sharing success stories of how quality measures make a difference for patients (this helps with provider and staff buy-in, which is key).

MIPS/MACRA

If you participate in Medicare’s MIPS program, we help maximize your score. We ensure you’re capturing all possible points by hitting high performance on Quality measures (where we directly influence outcomes) and Improvement Activities (some of which our programs can fulfill, such as care coordination activities). We document our interventions to serve as evidence for attestation if needed.

Utilization Management

For ACOs or value-based contracts, quality is tied with utilization outcomes. Our services demonstrably reduce undesirable utilization (ER visits, readmissions) by bridging care gaps. For instance, our transitional care program can significantly cut readmissions – a key metric in ACOs. Our medication management and remote monitoring can help reduce ER visits for things like uncontrolled hypertension or diabetes. We closely watch metrics such as all-cause readmission, ED visit rate per 1000, etc., and adjust our strategies to target outliers. For example, if data shows a cluster of CHF patients had multiple exacerbations, we might initiate a special CHF outreach program or RPM with scales for them. This dynamic approach keeps you ahead of the curve. Notably, one advantage we provide to practices and ACOs is improved performance without additional burden, since we handle the tasks. Clients can improve quality performance “at no extra cost” by leveraging such care management services – our integrated approach means you’re basically getting quality improvement baked in.

Patient Education

Quality care is ultimately about patient outcomes, and an engaged patient is more likely to achieve good outcomes. So, part of quality management is patient education. We implement targeted education campaigns, like teaching patients with diabetes about the importance of eye exams or foot care (to improve those measures), or educating patients with hypertension on low-salt diets and medication adherence (impacting BP control measure). We take the time to educate, which your busy providers might not always be able to do in a short office visit. This creates a virtuous cycle: educated patients -> better self-care -> better metrics.

In conclusion, Brilliant Care’s Quality Management is not a separate silo – it’s woven into everything we do, creating a comprehensive safety net of quality. We operate on the principle that high patient engagement and optimal clinical outcomes are two sides of the same coin. By partnering with us, you gain a robust infrastructure to drive quality improvement continually. We take pride in not just meeting benchmarks, but exceeding them and demonstrating that top-tier metrics are attainable for every one of our clients. Let us handle the tracking, the chasing, and the fine print of quality programs, so you can reap the rewards of being a top performer in clinical quality.