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Data Science

Jaime improves HEDIS® process & performance*

April 25, 2017
Advanced analytics offers a strategic, cost-effective solution to improve HEDIS® performance.
President and CEO

One feature our clients like most about our Theon® advanced analytics platform is the ability to license it in two ways:

1. Some health plans want one comprehensive solution to manage value-based contracts, participating providers and member health.

I’ve written extensively about the health plan leaders who’ve benefitted from their plan’s decision to deploy our Theon® platform in different areas of the organization, including:

  • Val - A health plan leader who trimmed claims cost by two percent
  • Sam  - A health plan IT leader who saved $3.1 million by sunsetting legacy software

2. Other health plans want to license the Theon® solution to solve a distinct business challenge, such as cost-effectively improving HEDIS® performance.

That’s what Jaime’s health plan did. At her direction, the plan licensed the Theon® platform to simplify and speed up the HEDIS® process for the plan and especially for participating providers. She also wanted to reduce the costs and organizational lift associated with what had become the annual fall ‘chart-chasing’ season.

Anyone who’s worked on the health plan side of HEDIS® measures and Medicare Star ratings is all too familiar with the late summer and fall scramble to close as many care gaps as possible. Health plans send teams of nurses to provider offices to review thousands of charts, and many plans use expensive, labor-intensive, one-off tactics like mobile mammograms and bone density scans. And then have to do it all over again the next year.  It’s quite costly to health plans and frustrating for participating providers.

The Theon® Platform: A Strategic Solution for HEDIS® Improvement

Jaime’s desire for a strategic solution – one that improved quality measure tracking for providers and supported processes that could be used each year – led her to choose the Theon® platform.

As the result of her many years working on HEDIS® and quality performance, she knew her health plan and participating providers needed timely information about care gaps for attributed patients – and by timely, I mean monthly reports and even weekly or daily updates as the end of the reporting year nears. In other words, both parties needed to work in the same tool, share the same updated information, and, as the result of continuous, year-round monitoring, know precisely where – and where not – to direct limited resources. Rather than waiting until the end-of-the-season rush, the constant identification and prioritization of members in need of initial or follow-up services enables health plans like Jaime’s and participating providers to address care gaps as information becomes available – and this inevitably eliminates duplicative efforts, reduces costs, and increases satisfaction for health plan, providers and members. 

  Patient Explorer  Theon Platform
The Theon® Platform Leverages Clinical and Claims Information to Automatically Close Care Gaps and Simplifies the Submission of Supplemental Data

Improving Physician Satisfaction

Just as importantly to the network providers in Jaime’s health plan, the Theon® platform greatly simplifies the submission of supplemental data, which is often required to close a care gap, and does so within the physician’s existing workflow. The Theon® platform integrates member information from 25 or more sources, allowing some gaps to be closed automatically rather than through chart chasing. For other gaps, in lieu of faxes to the health plan, physicians and their staffs use our platform’s built-in, streamlined submission capability to easily add information to the member record.

It’s been nearly 18 months since Jaime began using the Theon® solution to improve her plan’s HEDIS® performance and process, and it’s working just as intended. HEDIS® numbers are up, chart chasing is down, participating physicians are more satisfied, and the total costs of her program are lower. In Jaime’s words, “Deploying the Theon® advanced analytics platform has been a triple win: a win for members, a win for providers and a win for the health plan.”

For more resources on how to improve HEDIS® performance, download our white paper, 10 Ways to Improve HEDIS® Reporting and Quality of Care for Members.

*Jaime’s experience is an illustrative example based upon the actual experience of a Geneia client. This information is provided for illustrative purposes only. Jaime is fictional and not intended to represent any specific person. Any direct similarities to any real person are purely coincidental and unintentional.