Quality Management

Advancing Care Standards Through Measurable Outcomes and Strategic Oversight

Improving healthcare quality isn’t just a mandate—it’s a mission. At ProspHire, we partner with health plans and providers to elevate care delivery by embedding quality at every level of the organization. Our mission to support our partners by having the member at the core of our solutions that are designed to help organizations achieve measurable gains in clinical outcomes, member satisfaction and regulatory performance.

Successfully navigating complex quality programs like Medicare Stars, HEDIS and NCQA Accreditation requires more than a one-size-fits-all approach. Every organization is unique and developing the right strategy tailored to your specific needs is critical to achieving meaningful, sustainable results. It demands a strategic, data-informed approach that aligns quality initiatives with broader business goals. ProspHire brings deep regulatory knowledge, full spectrum of government programs expertise and a hands-on delivery model to ensure our clients stay ahead of evolving quality standards while driving meaningful improvements in care.

Our work spans the full quality lifecycle—from assessing baseline performance and identifying gaps, to implementing interventions and measuring impact. Whether you’re looking to improve scores, meet accreditation standards or build sustainable quality programs, ProspHire serves as a trusted advisor and execution partner, helping you drive results that matter to both your organization and the populations you serve.

Every organization is unique and developing the right strategy tailored to your specific needs is critical to achieving meaningful, sustainable results.

How ProspHire Can Help

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Addressing Health Disparities

Building equitable care strategies by identifying and addressing disparities across populations. ProspHire applies data-driven analysis, community engagement and programmatic interventions to help organizations reduce inequities and improve outcomes for underserved and at-risk groups.

HEDIS Optimization

Maximizing Healthcare Effectiveness Data and Information Set (HEDIS) performance through robust data analytics, measure-specific interventions and provider collaboration. ProspHire helps organizations close care gaps, improve member outreach and drive sustained improvement across clinical quality benchmarks.

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NCQA Accreditation

Guiding organizations through the National Committee for Quality Assurance (NCQA) accreditation process with confidence and efficiency. We assess current practices, identify improvement opportunities and support the implementation of standards-based solutions to elevate care quality and organizational credibility.

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Behavioral Health

Strengthening behavioral health programs through targeted quality interventions, care coordination models and metrics alignment. ProspHire helps clients navigate the unique challenges of integrating behavioral health with physical health, ensuring high-quality, patient-centered care that improves outcomes and meets evolving standards.

Interoperability and ECDS/dQM Readiness

Preparing organizations for digital quality reporting by advancing their readiness for Electronic Clinical Data Systems (ECDS) and digital Quality Measures (dQM). ProspHire helps integrate disparate data sources and align reporting capabilities with regulatory expectations—bridging the gap between clinical systems and quality measurement frameworks.