This is Health Care Quality Week, a time to recognize that every quality measure represents a person, a need, and an opportunity to make a difference.

In Medicare, Quality and Star Ratings help measure how well we deliver care. But the real impact is not found in a score. It is found in the patient who receives an early diagnosis, avoids a preventable complication, or gets the support needed to stay healthy through primary and secondary prevention.

At ConcertoCare, our members often have complex medical, behavioral health, and social needs. For many, the best place to close a gap in care is at home.

Some quality measures can’t be addressed with a phone call or a mailed reminder. They require a clinician to be present. In our case, the most practical exam room for a patient with complex health and social needs may be their kitchen or den.

That’s why why our providers and field nursing teams make home visits with a specific focus on quality, alongside the urgent and longitudinal management of members’ chronic conditions.

We have a strong track record of helping our health plan partners achieve 4 STARS or higher on a range of quality measures, including diabetic retinal eye exams, Care for Older Adults functional status assessments and medication reviews, colonoscopies, and mammograms.

Achieving this level of performance among a population with significant medical and social complexity is especially meaningful. It reflects the dedication of our clinical and quality teams and the trust they build with our patients.

Consider a few examples.

Diabetic retinal exams can identify eye disease before it leads to vision loss. They can also reveal vascular changes associated with broader cardiovascular risk, creating another opportunity to identify complications and connect patients with appropriate follow-up.

Cancer screenings can be difficult to prioritize when patients are already managing multiple chronic medical and behavioral health conditions. Having these conversations in the home, where patients may feel more comfortable and in control, can help overcome barriers. When appropriate, we can also help members access at-home colon cancer screening options.

Medication reviews and in-home assessments offer another important advantage. We can see which medications patients actually have, understand how they manage them day to day, and perform appropriate physical examinations and diagnostic assessments. For members facing mobility limitations, transportation challenges, or complex health needs, this can make a meaningful difference.

These encounters allow us to identify problems earlier, close gaps in care, and help patients stay on track.

We are proud of this progress, but we know there is more to do. Our members come first, and I am grateful to our field nursing, quality, provider, and interdisciplinary teams for the work they do every day to orchestrate the care and improve the outcomes for the patients we serve.