Health plans: Improving HEDIS® reporting among providers can improve your rankings | Geneia

Health plans: Improving HEDIS® reporting among providers can improve your rankings

September 08, 2016
Dawn Milstead, BSN, MBA, Vice President, Clinical Innovation, Geneia


The National Committee for Quality Assurance (NCQA) provides the gold standard in health plan scoring and ranking across the nation. Consumers, employers and health plans themselves rely on NCQA scores and accreditations to accurately evaluate and compare the quality of care and service delivered by health plans. The information is updated annually and is used to help consumers and employers select the health plan best suited to their needs.

The Healthcare Effectiveness Data and Information Set (HEDIS®) drives NCQA accreditation scores for health plans. In fact, NCQA revealed that 37 percent of each health plan’s accreditation score is derived directly from plan performance as reported through HEDIS® measures.

Health plans must develop strategic approaches to delivering and reporting HEDIS® measures or risk unfavorable scoring that is highly publicized and lowers their perceived value in the eyes of consumers.

Health plans understand the importance of HEDIS® reporting. Because some HEDIS® measures focus on care delivery, responsibility for reporting also rests with providers. Unfortunately, providers often view this task as yet another layer of paperwork that detracts from patient care, consumes valuable time, provides no direct financial incentive, and diminishes their joy of medicine.

In the past, health plans supplied reams of paper HEDIS® reports to providers, overwhelming them with often-outdated information and causing them to waste time and effort closing care gaps that no longer existed. Thankfully, times have changed.

Today, health plans can leverage sophisticated and integrated analytics platforms, like the Theon® platform to:

  • Motivate provider compliance
  • Ease reporting burden
  • Evaluate provider effectiveness
  • Target high-value measures to increase star ratings
  • Monitor and improve ongoing performance

To learn more about how your health plan can improve HEDIS® reporting among providers to boost NCQA ranking and accreditation scores, download our free white paper.


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