Quality Scoring: How predicting outcomes can lower healthcare costs

Quality Scoring: How predicting outcomes can lower healthcare costs

For employers looking to reduce their healthcare spend, the immediate first step might be to focus on straightforward ways to lower prices. But healthcare decisions based solely on cost often overlook a critical factor: the quality of the outcomes of care.

Today, one of the leading self-funded employer solutions involves a more holistic approach by incorporating quality scoring into healthcare strategies. By identifying providers with proven clinical outcomes and steering members towards them, employers can improve care experiences, reduce avoidable complications, and lower total healthcare costs over time.
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What is quality scoring?

Quality scoring evaluates healthcare providers and facilities based on performance, measured by clinical, utilization, and outcomes data.

Rather than focusing only on a provider’s or facility’s price, quality scoring considers comprehensive factors such as:

• Clinical outcomes

• Complication and readmission rates

• Cost efficiency

• Peer comparison

• Procedure success rates

• Adherence to evidence-based care guidelines

These insights identify providers who consistently deliver high-quality care and better long-term results.
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Why measuring outcomes matters

If members choose care based solely on cost, they may select a cheaper, but lower-quality provider. This choice will save money in the short term, but they may also experience complications, require additional procedures, or be readmitted to the hospital – all of which adds up to more costs.

On the other hand, when members select providers with strong track records of positive outcomes, health plans often see significant long-term savings. Choosing providers with high quality scores often reduces:

• Emergency department utilization

• Hospital readmissions

• Repeat procedures

• Recovery times

High-performing health plans empower members to make decisions based on outcomes rather than price alone, leading to better quality care and lower downstream costs.
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A smarter approach to healthcare decisions

Quality scores provide a complete picture of a provider’s value by helping predict which ones are most likely to deliver successful outcomes. When members consistently receive care from high-quality providers, the result is long-term cost savings and sustainability for the health plan.

OneVeracity’s Guided Care Pathways Program, a part of Care Solutions, offers real-time quality scoring to drive members toward high-quality, cost-efficient providers. It also includes care navigation programs, in which Care Solutions navigators reduce administrative burden on members by ensuring providers shown are accepting patients and have appointment availability. 

Care Solutions empowers employees to enhance member care while protecting their plan’s sustainability.
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The bottom line

Pursuing effective healthcare savings comes down to making better decisions – not just finding the lowest prices. Quality scoring helps employers move toward value-based healthcare strategies that support long-term plan sustainability.

Learn more about how Care Solutions utilizes data-driven insights, care navigation, and comprehensive quality scores to help self-funded employers achieve better clinical outcomes at a lower total cost.

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