Case Study: a growing primary care provider boosts quality performance with Navina

Navina boosts 2023 quality performance for risk-bearing provider organization

A growing primary care provider organization in Florida and Texas was facing challenges in efficiently managing care gaps and risk adjustment documentation as it expanded its Medicare Advantage plans. With only a single care team coordinator, it was difficult to keep clinicians engaged and scale their value-based care workflows. The provider partnered with Navina, utilizing its AI-powered quality performance platform integrated with their eClinicalWorks EHR.

Navina's platform used its AI and natural language processing to automatically reconcile care gap files with clinical evidence from the EHR. This solution identified opportunities to close gaps and file for exclusions. Within two months, Navina helped boost the organization's overall quality performance rate by 16%, significantly improving HEDIS measures and helping several reach higher CMS star ratings. This resulted in meaningful financial returns and cost savings, allowing the organization to confidently take on more risk contracts while maintaining its single care team coordinator.