PERFORM+ Regulatory is part of CitiusTech’s PERFORM+ Suite of products which enables payers to accelerate quality reporting, enhance collaboration for gap closure and improve HEDIS scores, in a near real-time environment. It provides health plans with comprehensive insights that help with risk management, provider engagement and quality improvement.

Solution Focus: To ensure continuous business growth, Health plans need to retain current members and attract new ones each year. HEDIS scores are an important measure of the quality of care provided to a health plan’s members which makes it critical to monitor and improve them. PERFORM+ Regulatory offers Health plans with a modular, comprehensive, and scalable HEDIS management solution.

Key business use cases:

Member 360: Configurable analytical tools & dashboards (including Member 360, Measure 360) to improve decision making and accelerate gap closure

Charts retrieval & data acquisition and sharing: Enable chart chase, abstraction, and Campaign management for managing chases and provider engagement

PERFORM+ Regulatory Modules:

Measure Engine: Configurable at the speed of business with output that can be audited and available in various formats

Medical Record Review: Integrated MRR with real time compliance update and configurable automated workflow

Submission: Seamless error free submission across NCQA HEDIS®, CMS and other State agencies

Analytics & Reporting: Suite of pre-built, configurable analytics tools, dashboards, and rich visualizations (Member 360, Provider 360, gaps-in-care etc.)

PERFORM+ Regulatory Advantages:

Near Real-Time Computation: Carry out daily / weekly processing for accelerated coordination and scale at the speed of business

AI/ML Performance Library: Improve quality planning decisions, segmentation, chase intelligence and data enrichment

FHIR Enablement: Available accelerators and expertise for executing FHIR/Interop use cases for ‘gaps in care’ alerts

Optimize Provider Outreach: To increase provider collaboration by identifying the right provider to chase and to close the right gaps

PERFORM+ Regulatory - Regulatory Performance Management

by CitiusTech