Hot Take: The Key to Closing Gaps in Care and Increasing HEDIS Scores and Star Ratings

This week's episode is a quick hot take on innovative approaches to enhancing  healthcare quality and equity with Nakecia Taffa, Director of Quality Improvement and Healthcare Equity. Discover how individualized care plans and digital engagement programs can close care gaps, enhance HEDIS scores, and elevate Star ratings. Listen as Nakecia shares her extensive experience and compelling stories, revealing the real-world challenges and successes in activating population health nurses and scaling the capabilities of care coordinators. 

Listen and Learn:

• The unique methods used to engage members and implement value-based care models effectively
• Ways to empower both members and healthcare professionals that leads to better outcomes for all 

Expert: Nakecia Taffa, Director of Medicare and Medicaid Quality Improvement and Healthcare Equity, GoMo Health

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Episode Transcript

Speaker 1 (00:00):
There are times in the world and life when a
discovery changes how we dothings.
Hi, I'm Shelley Schoenfeld.
Join me on this journey ofdiscovery as we unfold a whole
person health delivery sciencefor people in need.
Welcome to Human ResilienceChanging the Way Healthcare is
Delivered.
In this episode, we'll hearfrom Nikesha Tafa, certified

(00:21):
Specialist in Payment andReimbursement, who will share
her expertise in qualityimprovement and health equity,
focusing in this take on how toclose gaps in care and increase
HEDIS scores and star ratings.

Speaker 2 (00:34):
Okay, my name is Nakisha Taffa.
I am the Quality Improvementand Health Equity Director at
GOMO Health.
I've been in healthcare for thelast 20 years.
I am a nurse, working indifferent quality improvement

(00:55):
departments within payerorganizations and provider
networks, having a very uniqueposition to be both
member-facing facing and workingin a health plan, so helping to
manage those provider networkswith their care gaps.
So I would disseminate the caregaps to these different

(01:15):
healthcare provider networks,I'm sorry, and let them know
what was compliant and what wasnon-compliant.
So you have a broad range ofmeasures, okay.
So whether they are compliantwith diabetes or blood pressure
or immunizations or anypreventative care screenings, I

(01:37):
would take this to the providernetwork and I would go over
their reporting with them.
I would go over their valuebased contract with them to
ensure that they are closing thegaps in care.
Ok, so what happened in myexperience was that larger
provider network would thentrickle down those reports to

(01:59):
each individual clinic clinic.
Okay so, they all landed on thedesk at an individual clinic
and, whether that was my caregap report or a care gap report
from a different payerorganization, that lady was
tasked or young man was taskedwith the chore of understanding

(02:21):
those value-based care models orother pay for performance
models and outreach to membersto get them in for needed
services.
That is how it played out.
I would then leave that reportand I'd say, okay, I will be
back to run another report andjust see how many care gaps were
closed Throughout my career.

(02:43):
What I realized is that doesn'twork.
That doesn't work.
Those people put blinders onbecause they do not have the
capacity to do the work.
We had to find ways to thinkoutside of the box to get them
to outreach to members.
They have the entire clinic torun other duties assigned.

(03:06):
So my passion became how do Iactivate those population health
nurses or coaches or casemanagement team to then in turn
reach out to those members toclose those gaps, which is the
health plan's goal.
So what I realized is thatthere is a very distinct way to

(03:32):
create this activation andmember engagement so that the
health plan could actuallyrealize their return on
investment right, theirinitiatives, aligning those
processes.
So it wasn't about just goingout and say, close these care
gaps, we needed to start lookingat gaps in processes as well.

(03:53):
I realized that GOMO was anextension of the health plan,
the provider network, everythingI did in the quality
improvement department,population health and case
management, and the outcomesthat they were able to achieve
is everything that I worked forfor over 12 years.
I had an opportunity to workwith great people at different

(04:15):
organizations, but we know thatsometimes the best laid out
plans short if we don't putcertain things in place to scale
the ability of these carecoordinators.
So what I actively do at GOMOis really create visual

(04:36):
frameworks across allvalue-based care models.
No matter what contract youhave, you have a population of
members and we need to know howto engage them.
That is what we do here.
We we we create plans andindividualized plans becoming a
part, an extension, if you will,of the health care journey for

(05:00):
these members.
Putting the member first,activating those care
coordinators.
I learned to listen Once Istarted listening to my little
ladies behind the desk.
I understood that there was notjust here's.
Your report is how do I empowerthem and activate them to scale

(05:22):
what they needed to do?
They may call a 100 membersright through the course of the
week, but they've got a reportof 10,000 members, right?
They have a 10,000 memberreport just from me, not to
include other payers, right?
How do I activate that?
We activate that by customizingand individualizing care plans

(05:47):
for each member.
That's the difference of 100people being called that week,
50 people scheduling, 25 show up.
10 have social determinants ofhealth factors.
We can scale that.
You may have engagement for10,000.
5,000 show up.

(06:09):
We've addressed 10,000 socialdeterminants of health issues
and we may have 4,000 membersshow up.
That's the scalability andactivation we are able to create
.
That is what we were missingwhile I was sitting at my desk,
overwhelmed and tasked with howdo I get them, to get these

(06:31):
members in, to close these gaps,increase the heat of stars and
cap scores for my health plan.