Helping health plans improve quality performance through better data, stronger operations, and practical execution.
Contact UsPerformance issues can trace back to data flow, reporting operations, vendor performance, accountability, or staff capacity.
KHS traces the problem to its source, sets priorities, and works with your team through implementation.
Focused support across quality performance, reporting operations, data, technology, and implementation.
Identify what is driving results and turn the findings into prioritized action across measures, operations, governance, and member experience.
Sharpen reporting operations, medical record review, audit, and validation, grounded in direct CMS and NCQA-side experience with ECDS and digital-measure requirements.
Trace how quality data moves, expose documentation and processing gaps, improve data usability, and define future-state requirements.
Define requirements, build RFIs and RFPs, compare capability and cost, recommend finalists, and support transition planning and vendor oversight.
The KHS Difference
You work directly with healthcare leaders who owned, led, and delivered these functions inside CMS, NCQA, and regional and national health plans—not consultants working from outside.
Senior leaders providing experienced guidance and support.
Focused assessment that moves into recommendations and execution.
Experienced capacity embedded with your team.
A Medicare Advantage plan needed to protect Stars performance but lacked a clear view of its financial exposure and highest-priority gaps. KHS assessed the program, quantified up to $15M in potential Quality Bonus Payment exposure, and prioritized actions across governance, measurement, and operations.
A regional health plan needed to improve HEDIS results during reporting season with limited staff capacity. KHS redesigned the research workflow, reviewed 990 chases covering 454 members, identified 97 actionable findings, and increased productivity from 1.78 to 3.85 chases per hour.
A regional health plan needed more reliable HEDIS results but could not trace failures through its data and abstraction processes. KHS reviewed more than 300 documents and identified approximately 1,300 unsuccessful abstractions involving non-attributed members and 5,000 rows with record-identification issues, creating a specific correction agenda.
A Medicare Advantage plan needed to compare vendor capability and cost without relying on sales claims alone. KHS developed a 104-question RFP, scored responses against 193 weighted requirements, completed a cost-effectiveness analysis, and recommended three finalists for demonstrations.
Whether the issue is a performance decline, a vendor decision, unreliable data, HEDIS operations, digital quality readiness, or an initiative that isn’t moving forward, the first step is determining what is actually driving the problem.
KHS assesses the situation, clarifies the choices, and defines a practical path forward.
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