For health plans, achieving high-quality performance means balancing clinical excellence, financial sustainability, and compassionate, patient-centered care. Palliative care programs uniquely advance all three—improving outcomes for members with serious illness while supporting health plan quality metrics, including HEDIS® and Medicare Advantage Star Ratings.
The National Committee for Quality Assurance (NCQA) understands that standard quality metrics don’t always apply to patients with advanced illness. For this reason, NCQA excludes palliative care patients from fifteen key HEDIS measures. This ensures health plans are not penalized when these members decline screenings or interventions that don’t align with their goals of care.
This flexibility allows plans to strategically invest in palliative care programs while focusing on clinically relevant, patient-centered outcomes—without pressure to chase inappropriate metrics.
Because HEDIS measures are a major driver of Medicare Advantage Star Ratings, these exclusions have significant implications. By removing palliative care patients from certain measures, health plans can:
Beyond exclusions, palliative care’s ability to reduce avoidable hospitalizations and emergency department visits improves utilization-based measures, directly supporting both quality performance and financial objectives.
At Vynca, our palliative care model delivers measurable impact:
These results directly support quality improvement, cost containment, and member experience goals.
Advance Care Planning (ACP) is now a dedicated HEDIS measure. Palliative care teams are uniquely positioned to facilitate meaningful ACP conversations and documentation, consistently driving completion rates well above national averages.
Vynca’s outcomes demonstrate this leadership:
By achieving nearly triple the national average, Vynca not only ensures care aligns with member preferences but also positions health plans to succeed in meeting regulatory requirements.
Beyond quality reporting, palliative care improves the lived experience of members:
These metrics highlight the depth and quality of clinical relationships, driving better outcomes and stronger member experience scores—both critical components of Star Ratings.
By integrating palliative care into their benefit strategy, health plans can:
Palliative care is more than an added benefit—it’s a strategic lever that strengthens quality performance, aligns with NCQA and CMS standards, and measurably improves outcomes for members with serious illness.
Vynca’s proven impact—spanning reduced hospitalizations and ED visits, higher ACP completion, and superior patient satisfaction—makes palliative care both the right thing to do for members and the smart thing to do for business.
To learn more about how Vynca can support your practice, or to refer a patient today, visit vyncacare.com, email us at hello@vyncacare.com, or call 1-888-227-8884.