New Year, Make This HEDIS® Season Better

February 08, 2017
Dawn Milstead


I’m not a fan of New Year’s resolutions, but this year, I’m asking you to join me in making this year’s HEDIS® season more enjoyable – at the very least, make it a whole lot less administratively burdensome for everyone involved.

As the head of a clinical outreach and engagement team deployed on behalf of health plan clients, I can assure you that my team’s talent serves member populations better when aimed directly at facilitating member outcome improvement, rather than at chasing down charts for HEDIS® reporting.

For each of the past two years, my team has dramatically improved the value of their role in reducing the HEDIS® scramble while improving reporting because our health plan clients deploy and trust the Theon® platform in four specific ways:

  1. To incorporate specific HEDIS® targets in shared savings contracts (for example, cancer screening (breast, cervical, and colorectal) and management of chronic disease, such as diabetes)

     

  2. To continuously monitor HEDIS® measures to view trends at the population and individual patient level throughout the year

     

  3. To leverage enriched data to gain a deeper understanding of member health and compliance with preventive and chronic care screenings. Because the Theon® platform integrates clinical and claims data, we can better determine not just that a member had an appointment, but what was done and how the member is doing.

     

  4. To push out reminders to providers with open HEDIS® opportunities -- reminders that stay within the clinical workflow.

Automate the most onerous of HEDIS® tasks to simplify reporting.

 

One of the greatest challenges to successful HEDIS® submissions is the sheer drudgery of the tasks involved. However, this is an opportunity for technology to lighten the load and enable everyone to focus on improving compliance and member health. Much like email has simplified and sped up communications, the Theon® platform speeds up and simplifies the HEDIS® process in six streamlined steps:

 

  1. The presentation of (usually monthly) HEDIS® reporting reveals health plan and provider specific compliance rates on a routine basis throughout the year.

     

  2. The platform generates a reminder that automatically appears in the health plan and provider dashboards.

     

  3. The health plan accesses the reminders, in their workflow to facilitate collaboration with appropriate providers.

     

  4. The provider receives the reminder within their clinical workflow.

     

  5. The provider addresses the gap or opportunity in an upcoming appointment or reaches out to the member to schedule an appointment.

     

  6. During the appointment, the provider takes the necessary steps to close the HEDIS® care opportunity and notifies the health plan seamlessly via the Theon® platform. The provider can easily attach required supplemental information, if necessary, at the click of a button.

 

Additionally, the Theon® platform recognizes and issues reminders on measures that intersect with other quality measure sets (such as Stars) to help prioritize outreach, reduce redundant reporting and improve scores (read about how we helped one health plan client significantly improved their Medicare Star rating.)

 

Monitor HEDIS® progress continuously throughout the year.

 

This functionality delivers a lot of bang for your buck. The ability to monitor progress of reported HEDIS® measures throughout the year enables us to course correct all year long. Instead of waiting for the end of the year scramble, we know – at all times – exactly where we stand and have time to make any necessary changes.

By sharing these early results with providers, they can proactively monitor and manage member health, address issues early, prevent further complications, and report on the delivery of preventive and chronic care services within an easy-to-use, intuitive analytics platform.

Let’s make this HEDIS® season a little easier for everyone.