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How to Achieve Excellence in HEDIS

temp771
Nov 5, 2015
2 min read

The “E” in HEDIS stands for Effectiveness, but how can you turn that into excellence for your organization? Here are five must have’s and must do’s to achieve HEDIS excellence.

1. Surround yourself with excellence. a) Hire staff with HEDIS experience and a track record of excellence. b) Partner with vendors who deliver high quality results. c) Invest in technology and solutions that optimize your HEDIS efforts. Excellence begets excellence.

2. Build out your timeline and HEDIS project plan. As the saying goes, “Proper planning prevents poor performance.” a) Be comprehensive in your planning, and include your HEDIS vendor partners in the process. b) Prepare for common roadblocks like source data issues or technology challenges. c) Schedule data loads and measure processing so that you can start hybrid chart reviews as early as possible. Time is a most precious HEDIS resource.

3. Maximize your supplemental data sources. Although NCQA has tightened the guidelines, there are still many opportunities for supplemental data sources that can improve your HEDIS results. Some common examples: a) Lab results data from laboratories and hospitals b) Immunization data from state registries c) Electronic medical record (EMR) data from high-volume provider organizations d) Year-round chart collection and abstraction for targeted measures e) In-home assessment vendor data

4. Monitor ongoing HEDIS results. High scoring health plans generate HEDIS results year-round, on a monthly or sometimes quarterly basis. a) Prospective reporting tracks your progress towards the upcoming HEDIS submission, and identifies the members and providers to target for member and provider outreach. b) Retrospective rolling 12-month HEDIS reporting allows for consistent trending throughout the year. c) Monthly monitoring keeps your HEDIS results on the right track.

5. Knowledge is Power. a) Know the demographics of your membership, so you can craft meaningful member outreach. b) Know which provider groups require special treatment when it’s time for hybrid chart review. c) Know how your network contracting practices impact HEDIS source data, e.g. capitated providers, global OB billing codes, etc. d) Knowing the ins and outs of your membership, provider network and health plan practices is essential for HEDIS success.