Healthmine, a leading provider of technology-enabled member engagement and quality solutions, and Tenasol, a pioneer in AI-powered healthcare data transformation, announced a strategic partnership to deploy AI-powered, automated health actions for critical, time-sensitive Star measures.

Within the Medicare Star Ratings program, Transition of Care (TRC) and Follow-up After ED Visit for People with Multiple High-risk Chronic Conditions (FMC) are two high impact measures requiring timely follow-up — 30 days for TRC and just seven days for FMC. These are especially challenging given events can occur unpredictably with limited insight available to drive immediate clinical intervention.

Healthmine and Tenasol are working to address this challenge, enabling health plans to proactively close clinical gaps, engage members faster and drive performance on complex, event-based measures. This partnership’s integrated capabilities address these challenges through:

• Real-time clinical transformation, powered by Tenasol’s AI platform, extracting timely evidence from clinical datasets, beginning with admission, discharge and transfer (ADT) data and integrating with Healthmine’s Quality Relationship Management™ (QRM®) platform.
• Seamless notification integration into QRM platform enables rapid, personalized outreach to members and providers.
• Real-time clinical gap closure, improving Star Ratings performance, risk adjustment capture and operational savings.

“Tenasol’s strength lies in ingesting diverse healthcare data, including real-time HL7 ADT messages—and normalizing it for immediate action,” says Teddy Gedamu, CEO of Tenasol. “Together with Healthmine, we’re filling a critical gap in the market: empowering plans with actionable, event-based insights to improve both quality outcomes and cost performance.”

Early engagement with health plan members following critical events helps reduce medical loss ratio (MLR) expenses by avoiding preventable readmissions and emergency care costs. While administrative data is widely used, integrating clinical insights is essential for timely and informed interventions remains a challenge for health plans.

“The ability to act immediately on care transitions is no longer a luxury — it's a necessity,” says Michael Hasbany, President of Healthmine. “Our partnership with Tenasol gives health plans real-time visibility into high-risk events, enabling faster clinical engagement and more meaningful outcomes. This offering sets a new standard for Stars performance, MLR management and member experience.”

This partnership empowers health plans to improve performance today while aligning with the National Committee for Quality Assurance’s (NCQA) 2030 Digital Quality roadmap. The joint solution is scalable to other high-priority follow-up HEDIS measures, such as Follow-up after Hospitalization for Mental Illness (FUH), an important metric for many Medicaid contracts, and Initiation and Engagement of Substance Use Disorder Treatment (IET), which is currently under consideration for inclusion in future Star Ratings performance measures.

By supporting data-driven quality improvement, Healthmine and Tenasol also enable health plans to advance key strategic priorities — including real-time clinical gap closure, enhanced diagnostic capture and risk adjustment, reduced readmissions and medical loss ratio (MLR) and a better member experience — ultimately driving stronger, long-term health outcomes.

 

Source: businesswire.com

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