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Quality Management

Risk adjustment, quality measures, and compliance

Close quality gaps, optimize risk adjustment accuracy, and ensure compliance with value-based care requirements. Turn quality metrics into revenue opportunity.

Regional Hospital System

20%
RAF Score Improvement
35%
Quality Gap Closure Rate
95%
HCC Recapture Rate
$1.5M
Avg. Annual Value

Platform + Partnership

Choose the model that fits your organization — self-service SaaS or fully managed service.

SaaS Platform

Self-Service
  • Full platform access for your team
  • Works across various EHRs
  • Quality work queues for staff
  • Training & onboarding included
  • Email & chat support

Hybrid

Flexible
  • Platform access + partial managed support
  • CareEco handles overflow or complex cases
  • Scale support up or down as needed
  • Shared responsibility model
  • Dedicated success manager
Quality Dashboard
4.2★
Star Rating
↑ 0.3
73%
Gap Closure
↑ 8%
1.12
RAF Score
↑ 0.08
AWV
312 patients
A1C Control
186 patients
Colonoscopy
224 patients
142 patients schedulable this week — projected 0.3★ impact
Learn

Care Gap Identification

Identify care gaps and drill down to individual patients. Track performance by payer to ensure quality metrics are achieved without waiting on outdated reports.

Quality Work Queue
Patient Gap Queue
All PayersThis Week
PriorityPatientPayerGap TypeImpactAction
Miller, S. Humana AWV + HCC +$1,850 Schedule
Thompson, J. Aetna MA A1C +$420 Outreach
Garcia, M. UHC Colonoscopy +$380 Outreach
Brown, K. BCBS Mammogram +$290 Done
Enhance

Quality Work Queues

Quality work queues for staff to leverage in prioritizing their efforts. Monitor quality scores and plan more effectively with real-time data across various EHRs.

Patient Outreach
Outreach Campaign
AWV Campaign
SMS
Email
Phone
Your Branded Message
89% Delivery
34% Response
28% Scheduled
Act

Automated Patient Outreach

Branded text and email campaigns with customizable messaging. CareEco team utilizes text, email, and phone calls to engage and route patients to appropriate care locations.

Pairs with Chronic Care & Remote Monitoring Programs

Seamlessly integrate quality management with CCM and RPM programs to close gaps across the entire patient health journey.

Complete Quality & Risk Intelligence

HCC Risk Adjustment

Identify suspected and confirmed HCCs from clinical documentation. Ensure accurate RAF scores and capture risk adjustment revenue you're entitled to.

  • HCC gap identification
  • Suspect condition detection
  • RAF score optimization
  • V28 model compliance

Quality Measure Tracking

Track performance across HEDIS, MIPS, and ACO quality measures. Real-time dashboards show gap closure opportunities and compliance status.

  • HEDIS measure tracking
  • MIPS performance monitoring
  • ACO quality metrics
  • Star rating optimization

Patient-Level Gap Reports

Generate actionable care gap reports for each patient. Enable care teams to close quality gaps during routine visits.

  • Pre-visit gap summaries
  • Care opportunity alerts
  • Patient outreach lists
  • Gap closure documentation

Annual Wellness Visits

Maximize AWV completion rates and ensure proper documentation. Capture HCCs and close quality gaps during preventive visits.

  • AWV eligibility identification
  • Pre-visit preparation tools
  • Documentation templates
  • HCC recapture integration

Compliance & Audit Support

Maintain audit-ready documentation for RADV, OIG, and payer audits. Ensure your risk adjustment coding is defensible and compliant.

  • RADV audit preparation
  • Documentation validation
  • Coding accuracy review
  • Audit response support

Provider Performance

Track quality performance at the provider level. Identify coaching opportunities and recognize top performers.

  • Provider scorecards
  • Peer benchmarking
  • Trend analysis
  • Performance incentive tracking

Who Quality Management Is For

Medicare Advantage Plans

Optimize Star ratings, improve RAF accuracy, and maximize risk adjustment revenue. Close quality gaps proactively across your member population.

ACOs & Value-Based Organizations

Track quality measures across your attributed population. Ensure you're hitting benchmarks and earning shared savings.

Provider Groups

Improve MIPS scores, capture HCCs accurately, and demonstrate quality to payers. Turn quality performance into contract leverage.

Ready to Improve Your Quality Metrics?

See how Quality Management can help you close gaps, optimize RAF scores, and maximize value-based revenue.

Request Demo