By 2030, all baby boomers will be older than 65.1 Since older adults are disproportionately affected by chronic conditions—nearly 80% have 2 or more2—there is a heightened payer focus on chronic disease management and Medicare gap closure.
Recent changes in performance ratings are making it more challenging for payers to achieve the trifecta of effective population health management, profitability, and quality outcomes.
At Quest Diagnostics, we understand the challenges health plans face with closing gaps in care. Our solutions focus on your members as individuals with the goal of meeting them where they are in their health journey. In addition to helping improve member experience and health outcomes, our approach helps support health plan quality measure performance.
Our unique combination of quality lab data, actionable insights, and personalized member services can help your plan
Closing lab-related testing gaps may help improve quality performance scores, such as HEDIS and Medicare Advantage Star measures.
We offer 2 screening models to help you close lab-related testing gaps in a way that best meets the needs of your plan and your members.
Our value-based model takes a data-driven approach that offers the opportunity to test at Quest Patient Service Centers (PSCs) and/or at-home test kits.
At the start of the program, we analyze eligibility files provided by the health plan against existing lab data to
With this model, we only bill when the gap is closed.
Learn how our value-based screening approach helped Oscar Health close gaps in care by making screening easier and more accessible to members.
Our volume-based model takes a fee-for-service approach to closing gaps in care through at-home test kits only.
At the start of the program, we send test kits to entire eligibility file provided by the health plan.
We bill when the test kits are deployed and again when test kits are returned for processing.
From colorectal cancer (CRC) screening to kidney health evaluation for patients with diabetes (KED), we offer an approach that can help you close gaps in care and improve quality performance scores.
Quest Member Insights can provide access to prospective Quest lab test results for your current members and/or historical lab test results for your new members to empower your plan. We help health plans:
Member-based data
Access to comprehensive, prospective member lab test results, including results from hospital stays and other previous payer claims
Claims-based data
A data feed of prospective member lab test results billed to your organization
Historical data
Past lab test results of your current members
Pre-enrollment data
2 years of historical lab test results of your newly enrolled members
Read our analysis on how member-based data can help fill in gaps for quality reporting.
Social determinants of health (SDOH) not only lead to poor health outcomes and high healthcare costs, but they can also exacerbate health disparities, particularly for older adults, individuals with disabilities, and other underserved communities.5
Our Social Risk Factor (SRF) Screening solution can help health plans navigate the impact of SDOH on their members by delivering SRF screenings and targeted interventions. Our 4-pronged approach can help health plans identify social risk factors and close gaps in care with targeted interventions.
New and revised quality measures for health plan HEDIS gap closure issued by The National Committee for Quality Assurance (NCQA).
A new component of the Star Ratings program designed to incentivize Medicare Advantage plans to deliver equitable healthcare. Learn more.
Download our white paper where we explore updated recommendations by the Centers for Medicare and Medicaid Services to advance health equity.
Treating the whole person means treating all their conditions, and 42% of Americans have 2+ chronic conditions.6
Through digital health coaching, we focus on whole-person health by addressing multiple chronic conditions and comorbidities, including:
References
1. US Census Bureau. By 2030, all baby boomers will be age 65 or older. December 10, 2019. Accessed September 16, 2024. https://www.census.gov/library/stories/2019/12/by-2030-all-baby-boomers-will-be-age-65-or-older.html
2. National Council on Aging. Get the facts on healthy aging. August 16, 2024. Accessed September 16, 2024. https://www.ncoa.org/article/get-the-facts-on-healthy-aging/
3. Betbeze P. One-star improvement can increase Medicare Advantage revenue by 17%. Health Leaders. May 3, 2018. Accessed August 20, 2019. https://www.healthleadersmedia.com/strategy/one-star-improvement-can-increase-medicare-advantage-revenue-17
4. Bajner R, Meinkow E, Munroe J, et al. The impact of Star ratings on rapidly growing Medicare Advantage market. 2018. Navigant Consulting. February 2018. Accessed September 18, 2024. https://guidehouse.com/-/media/www/site/insights/healthcare/2018/medicare-advantage-analysis.pdf
5. Social determinants of health and Medicare Advantage: Policy recommendations to achieve greater impact on reducing disparities & advancing health equity for America’s Medicare population; 2021. Accessed April 4, 2024. https://ahiporg-production.s3.amazonaws.com/documents/SDOH-MA-IssueBrief-2021.pdf
6. Benavidez GA, Zahnd WE, Hung P, et al. Chronic disease prevalence in the US: Sociodemographic and geographic variations by zip code tabulation area. Prev Chronic Dis. 2024;21:230267. doi:10.5888/pcd21.23026&
7. The Institute for Functional Medicine. Health coaching as a strategy to enhance your practice. November 29, 2023. Accessed October 18, 2024. https://www.ifm.org/news-insights/lifestyle-health-coaching-strategy-enhance-practice
Let’s talk about how we can help you improve quality measure performance, lower costs, and enhance the member experience.
Please remember that email, including this web form, is not a secure method of communication. Do not submit personal information, including user names and passwords, social security numbers, or personal health information through this form.
Your Privacy Choices
Quest® is the brand name used for services offered by Quest Diagnostics Incorporated and its affiliated companies. Quest Diagnostics Incorporated and certain affiliates are CLIA-certified laboratories that provide HIPAA-covered services. Other affiliates operated under the Quest® brand, such as Quest Consumer Inc., do not provide HIPAA-covered services.
Quest®, Quest Diagnostics®, any associated logos, and all associated Quest Diagnostics registered or unregistered trademarks are the property of Quest Diagnostics. All third-party marks—® and ™—are the property of their respective owners. © 2025 Quest Diagnostics Incorporated. All rights reserved. Image content features models and is intended for illustrative purposes only.
