Quality Advisory Services
Maximize Quality Performance. Simplify Compliance.
Regardless of your line of business or quality reporting requirements, the ability to accurately monitor, measure, and improve your quality performance can make a significant impact on your organization’s financial success and the health of the people you serve.
Toney Healthcare works with health plans to optimize quality performance and compliance at all levels of your organization, ensuring your people, processes, data, and technologies are ready to meet organizational and regulatory requirements.
And we deliver results fast.
Our deep expertise in quality and regulatory compliance gets you up-to-speed quickly and helps you proactively manage your performance to improve satisfaction, maximize incentives and optimize your revenue.
Expertise In:
CMS
Stars
QRS
HOS
NCQA
HEDIS®
CAHPS®
URAC
QUALITY PROGRAM DEVELOPMENT
Structure a quality improvement program to support compliance, accreditation and other business needs—including program description, metrics, work plans, annual evaluation and quality committee structure.
COMPREHENSIVE QUALITY PROGRAM SUPPORT
Our experts share and tailor best practices to help you evaluate, monitor, audit, measure and report on your results so you can improve process effectiveness, enable regulatory compliance and prevent penalties.
GOLD STANDARD AUDIT & ACCREDITATION SUPPORT
End-to-end support for audits, accreditations and renewals including readiness assessment, process analysis, project management, staff training, on-site support and corrective actions.
DATA & MEASUREMENT
Design, develop and facilitate integration of industry-leading quality analytic and measurement systems and reporting with a focus on industry trends, regulatory quality requirements (NCQA, URAC, CMS), population health management and healthcare equity.
QUALITY ANALYTICS
Deep analytics expertise and development of strategies to ensure accurate and consistent measurement to maximize Star and other regulatory performance measures. Quantitative and qualitative analysis of results, improvement opportunities, action plans and effectiveness.
QUALITY MEASUREMENT COMPETITIVE MARKET ANALYSIS
Evaluation and benchmarking of existing strategies, emerging trends and opportunities relative to the market, plus solutions for best-in-class quality improvement.
QUALITY MEASURE TRAINING
In-depth education on quality measures and how they relate to health plan ratings, accreditation and financial incentives, personalized for your needs.
CLINICAL RESOURCES
Close care and quality gaps and improve metrics using highly trained clinical resources—with no hiring burden.
CUSTOMER ADVISORY SERVICES
Exceptional quality measurement expertise for your customers under your banner.
Speed quality improvement for maximum value.
People
Experts in quality across federal, state and local programs
Quality committee administration
Analytic expertise and project management
Staff training for quality programs and metrics
Program and staffing design and recruitment
Clinical personnel to engage with members and providers to close care gaps and improve quality metrics (e.g., Stars, HEDIS)
Processes
Quality assessment, planning and oversight
HEDIS roadmap and audit administration
Process analysis, improvement and waste reduction
Trigger analysis to identify quality of care opportunities
Member experience analysis to improve satisfaction and support CAHPS ratings
Data
Executive-level reporting & dashboards
Data hygiene and completeness studies
Data coordination, including data aggregator validation (DAV), electronic clinical data systems (ECDS), and other supplemental data
Population and provider analysis to support compliance and identify improvement opportunities
Technology
Custom measure development
Measurement engine and report design
Electronic clinical data system and digital measure migration
Quality data storage and systems
Software RFI/RFP support and scoring
