Health plans, hang on to your hats -- 2018 promises to be a year of notable changes to the continuously changing HEDIS® (Healthcare Effectiveness Data and Information Set) reporting requirements.
Next year will see the debut of seven new measures, changes to four existing measures and two “cross-cutting topics that address multiple issues across multiple measures.”[i] Changes include:
- New and revised behavioral health and chemical dependency measures (two of seven new measures address opioid use)
- New hybrid methodology to calculate a new transitions-of-care measure
- New and updated guidelines for measures using electronic clinical data systems (ECDS)
- Increased reliance on measure stratification
- Recognition of telehealth services as appropriate follow up for several behavioral health and chemical dependency measures
In addition to new and updated measures, health plans have one less week to meet the medical record review validation (MRRV) and interactive data submission system (IDSS) plan-lock deadlines.
Health plans must do more than just keep up. Each year, the NCQA® (National Committee for Quality Assurance) rates and scores health plans and makes those results publically available. These scores are used by employers, brokers and consumers to evaluate the quality of their chosen and prospective health plan. In an increasingly competitive and consumer-driven industry, quality is queen.
It’s About Open Care Opportunities
At its core, improving HEDIS® reporting means identifying and addressing the root causes of gaps in the delivery of preventive services and the management of acute and chronic conditions. It is our experience that care opportunities, or gaps, present themselves in three distinct ways:
- Internal processes
- Provider relations
- Member engagement
Diving deeply into each of these areas reveals strengths on which to capitalize and weaknesses to address. Internal processes, provider relations and member engagement must come into alignment around clear, measurable and reachable goals to improve quality of care and quality of reporting.
Address Organizational Barriers
Every health plan has organizational barriers to overcome. Often, we find HEDIS® teams working in isolation. This diminishes effectiveness and discourages the sharing of mutually beneficial data.
- Ask your HEDIS® team members if they feel disconnected.
- Search for common ground between their work and the work of others.
- Encourage those with common ground to collaborate and provide them with the means and even incentives to do so.
- Discover ways to share the work the team is doing and spread understanding about how their work is impactful to others in the organization.
HEDIS® is the foundation for many quality programs. Understanding the overlap enables health plans to focus resources where they will have the most significant impact.
Improve Provider Relations
Providers shoulder the responsibility for delivering and reporting HEDIS® measures. To improve provider reporting, health plans must make the process worthwhile and as easy as possible.
- Provide technology and improve workflow to do the heavy lifting and enable providers to focus on improving member health.
- Health plans with high NCQA ratings regularly share their knowledge, data and analytical insights with their provider network.
- Share the wealth – when incentives reinforce goals, change will come easier. It is becoming increasingly common for health plans to build HEDIS® compliance targets into payment contracts.
Analytics platforms, like the Theon® solution, uncover patterns across the provider network and within each provider site, thus enabling health plans the flexibility to customize contracts best suited for each.
Strengthen Member Engagement Year Round
Health plan clinical resources are limited in efficacy when directed too frequently at chasing down charts for HEDIS® reporting. Clinical resources serve member populations better when aimed directly and consistently at facilitating member outcome improvements throughout the year.
Engaging members and coordinating care throughout the year helps avoid the end-of-year rush – a rush that often results in more demand than providers can meet. Increased demand can lead to member frustration with wait times and services being sought out of network or beyond the required timeframe for HEDIS® reporting.
Beyond being busy, members must be willing to come into their providers’ offices and receive the identified services within the allotted time frame. To accomplish this, health plans must:
- Identify and understand member barriers
- Help members to overcome barriers
- Prepare clinical teams to succeed with all members, but especially those facing significant barriers
Download our whitepaper, 10 Ways to Improve HEDIS® Reporting and Quality of Care for Members, to dive deeper into strategies proven to increase and maintain successful HEDIS® quality reporting.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
[i] NCQA Updates Quality Measures for HEDIS® 2018. Retrieved from http://www.ncqa.org/newsroom/details/ncqa-updates-quality-measures-for-hedis-2018?ArtMID=11280&ArticleID=85&tabid=2659