Certified Quality Management, Built for Performance.
Drive Quality and Stars improvement, close gaps in care, and manage quality compliance across all your Medicare Advantage, Medicaid, ACA, and ACO populations — in one certified platform.
The Quality Platform Built for Precision and Performance
Quality programs are no longer just a compliance exercise — they're the engine of Stars ratings, quality bonuses, and value-based contract performance. EnsureQUAL™ gives health plans, MSOs, and provider groups the certified tools to drive measure performance systematically, not reactively.
From prospective identification of open gaps to retrospective coding closure, EnsureQUAL™ covers the full lifecycle of quality measure management — with provider-level insights that turn data into action.
Everything Quality, All in One Place
Certified Measure Calculations
The full quality measure library with a certified calculation engine. Accurate, audit-ready measure results your plan can trust for CMS reporting, quality bonuses, and Stars submissions.
Prospective Gap Identification
Identify open care gaps before the measurement year closes. Prioritize members with the highest likelihood of gap closure to maximize measure performance across your entire population.
Retrospective Gap Closure
Review and document retrospective compliance evidence. Identify services that were rendered but not coded, supporting supplemental data submissions and hybrid medical record reviews.
Provider Scorecards & Benchmarking
Measure-level performance scorecards for every provider and provider group. Benchmark performance against plan averages, identify outliers, and target education where it matters most.
Member Outreach Prioritization
Predictive member outreach lists ranked by gap-closure probability and Stars impact. Integrate with your care management teams to coordinate targeted interventions across populations.
Patient Experience Survey Management
Track patient experience survey domains alongside clinical quality measures. Understand member satisfaction drivers and their impact on your overall Stars composite score.
Built for Every Quality-Accountable Organization
Medicare Advantage Health Plans
Manage Stars-linked quality measures, supplemental data, and provider performance to optimize CMS quality bonus payments.
Medicaid Managed Care Plans
Track Medicaid-specific quality measures for accreditation and state contract performance requirements.
ACOs & Delegated Provider Groups
Support delegated quality program management, track ACO quality metrics, and optimize shared savings distributions tied to quality performance.
Management Services Organizations
Manage quality performance across multiple provider groups and payer contracts from a centralized dashboard, with standardized workflows.
- Improve Stars rating by 0.5–1.0 stars with systematic gap closure workflows
- Reduce manual quality abstraction labor with automated measure calculations
- Certified accuracy — results your audit team can stand behind
- Real-time gap dashboards eliminate the end-of-year scramble
- Provider engagement tools that drive accountability at the point of care
- Multi-payer support — manage MA, Medicaid, and ACA quality in one place
Ready to Improve Your Stars Rating?
See how EnsureQUAL™'s certified quality platform helps health plans, ACOs, and MSOs systematically close gaps in care and drive quality performance.