Quality Navigator – A First-in-Breed QI Solution

Over the past 8 years of our work, we’ve seen a lot of missing pieces in how we measure healthcare quality. One early key observation we made was that medical record review of clinical documentation was both critically important and simply not scalable without underlying NLP technology. That led us to develop Astrata’s Chart Review – the first primarily prospective HEDIS® NLP solution. Our next leap forward came with the introduction of eMeasure, the first NCQA-certified native FHIR and CQL HEDIS® engine. Built with the future in mind, this product is designed to take a health plan from 0 to 100 mph as FHIR data becomes widely available. Together, these two products lay the groundwork for quality measurement that can leverage all kinds of data (claims, unstructured, EHR, patient-reported outcomes), be done in close to real-time, scale to large populations, and reduce burden and cost to providers and payers.  

But clearly there was still something missing. We saw it over and over again in interviews with our customers and their provider networks. One provider asked – “Why am I getting gap lists that are filled with gaps I’ve already closed? How am I supposed to find the ones that I really need to close?” A quality team member said – “We can get data from our warehouse to help focus our QI campaigns but it’s a cumbersome process and takes a lot of time and manual effort”. At the core of both of these challenges is the exact same problem – accurate data to drive quality improvement is not available quickly and in usable form to the providers, quality team members, and care managers who need it to close gaps. 

Enter Quality Navigator – Astrata’s Quality Improvement-focused product that surfaces the data and analyses from our other products to deliver the highest quality data to QI teams. Quality Navigator integrates claims data from your existing traditional HEDIS® engine with NLP predications about which gaps are already closed and why they may still be open. As FHIR data becomes available, it will also incorporate structured EMR data to provide the most up-to-date and complete picture of a member’s quality measure compliance, driving new ways to intervene and improve member health.  

Quality Navigator identifies specific types of opportunities (we call them QIOs – Quality Improvement Opportunities) that can be used to set up distinct campaigns aimed at improving specific measures. For example, you can use Quality Navigator to identify members who have been given a FIT DNA or FOBT kit but are still noncompliant, so you can prioritize phone calls to these members to return the kits.

You can schedule delivery of reports to facilitate integrations to specific programs, teams, or vendor-based measure campaigns. And you can directly integrate this information into the Electronic Health Record (for example through our technology partner HOLON). Quality Navigator is designed to fit easily into your existing technology landscape – without disrupting your traditional HEDIS® engine or necessitating deep integrations with your enterprise data warehouse.  

Despite the light lift on your side, we think this new way of seeing your quality data will have a heavy impact. We see products like Quality Navigator as an important missing link in current HEDIS® technology – another element in our vision of where quality measurement is going.