Transforming your Quality operations with clinical data

May 28, 2021 | Resources, Solutions

Astrata’s Quality consulting services can help guide your organization through the strategy development process.

It all begins with data. If you’re a Health Plan on the journey to quality measurement and intervention across your entire population, the first hill you’ll have to climb is aggregating clinical data from your providers to feed your quality analytics machinery. But even before you start looking into your options for vendors and partners, there is something even more important to do.

You need a strategy

And your data aggregation strategy is likely to be very specific to your own organization, reflecting your company’s goals for growth and new lines of business, the distribution of your provider network, your approach to population health, and the new payment models and incentives you can offer. Some of the kinds of questions you want to ask as you prepare your data strategy are these:

  • Will we centralize data for mission critical analytics such as Quality, Risk Adjustment, and Payment Integrity?
  • Will our approach to data aggregation be direct-to-providers, through an intermediary such as a DAV certified Health information exchange, or both?
  • How will we incentivize our providers to engage in our data strategy, since they hold the keys to their EMRs?

In this phase of your Digital Measurement journey, you’ll bring in stakeholders from your business lines, as well as clinical leaders to build a multi-year plan and begin to prioritize your data sources. But to get to where you are going, you’ll need a way to travel. It’s time to start building your roads.

Building the roads

Like most health plans, your goal is to maximize the value of this transformation to your quality ratings and bonus payments. So you’ll need both structured EMR data and unstructured EMR data to get the best boost to your rates. But how will you get this data? The next step of your journey is all about connecting. Making the transition from chart chasing at the end of the year, to a stream of incoming data feeds, is a sea change.


  • What data will we need?
  • How many different EMRs will we need data from?
  • What’s the right tempo for incoming data?

Astrata’s data acquisition and engineering services help you aggregate data from across your provider network.

Constellation is Astrata’s state-of-the-art data platform combining a FHIR server and QI-Core with a sophisticated platform for clinical notes as well as rich APIs.

Creating your data oasis

As you bring in more and more EMR data, labs, observations, procedures, and conditions, as well as clinical notes in CCD, text and PDF – the next part of your journey is all about creating the foundation for your HEDIS transformation. A foundation that starts with a clinical data repository (CDR). Your quality data store will need to store data in the right data model so those computable measures to do their thing. But it will also need to store hundreds of millions of clinical notes, so that NLP algorithms can identify the rich quality information that only appears in text. And for both your structured and unstructured data, you’ll want something that you can stack other software on top of – with APIs to your data – so that you store once and use many times.

But you can still do the fun part first

Don’t make the mistake of thinking that you have to do all of these things first before you get to the fun part. With Astrata’s technology and services you can build incrementally, adding data over time, and continuously improving your clinical rates. You’ll be gradually switching your team over to year-round quality, supporting your goals in value-based care. And moving your operations to Digital Quality. That’s the way forward as your organization makes the journey to quality transformation.

Read this next…

What one year of ChatGPT has taught me about the future of Quality measurement – Part 1. The AI HEDIS Analyst

It’s been over a year since the release of OpenAI’s ChatGPT. And this is my first blog on the topic of how I think this new technology will fundamentally change healthcare Quality measurement and improvement. Why the wait? With the extraordinary flurry of activity,...

Quality Navigator – a first-in-breed QI solution

This month we're diving deep into a brand new Astrata offering - an archetypal, first-in-breed product with transformational potential for value-based healthcare. Quality Navigator represents the third product in Astrata’s overall quality solution suite, tying ...

Take Prospective HEDIS to the next level with an effective leads program

For those Health Plans that are already implementing a prospective, measurement-year program to close HEDIS gaps across your populations – know that you are taking one of the most important first steps towards Digital Quality, by realigning your workforce to a...

Six Reasons to Start Your Digital Transformation with Prospective HEDIS® Review

Navigating the transition to Digital Quality is like crossing a fast-moving stream. You want to get across without falling in and getting washed away! You may not know how long it will take to get across, but you don’t want to be stuck on the shore when the water...

Tackling Prospective HEDIS Review – Tips and Tricks

Many payers are either experimenting with or fully implementing a prospective HEDIS review process. If you're looking for strategies to optimize your prospective review, these ten tips and tricks will help you derive maximal value. Many payers are either experimenting...