Improving Quality Metrics for Medicare Advantage Patients

This case study examines the collaboration between payer and provider organizations, specifically Humana and Privia Health, alongside Bamboo Health, to enhance quality metrics and outcomes for Medicare Advantage patients. The focus is on the implementation of real-time information sharing to improve care coordination after hospital discharges. The study outlines the challenges faced due to a lack of timely data, which hindered effective care transitions. It details the pilot program aimed at closing care gaps and improving CMS Star Ratings, highlighting the importance of real-time visibility into patient data. The report describes regular stakeholder meetings that facilitated alignment and operational progress, as well as the customization of dashboards by Bamboo Health to track care metrics. Outcomes included improved adherence to quality measures and increased provider satisfaction. The study concludes with insights into future expansions of the program and software enhancements to further support care coordination efforts.