10 Proven Ways to Improve HEDIS Reporting and Quality of Care for Members | Geneia

10 Proven Ways to Improve HEDIS® Reporting and Quality of Care for Members

March 07, 2017
Shelley Riser, Vice President Consulting Services and Clinical Innovations


In our age of information, knowledge is everything and everywhere. As consumers, the spread of reviews and quality information guides every type of purchase we make from haircuts to dream homes. This attitude toward informed purchasing creates a fundamental shift in how we spend every dollar, whether at home or work.

Quality, and the perception of quality is queen.

The gold standard for health plan rating is the National Committee for Quality Assurance (NCQA) Health Plan Report Card. The report card aligns with CMS Star Ratings, is nationally recognized and widely distributed.

HEDIS® (Healthcare Effectiveness Data and Information Set) measures are the foundation for the NCQA report card (and other comparative reports).

Each year, NCQA rates and scores health plans and makes the results publicly available. Because the NCQA report card is a relative rating system, each year the bar is higher. Meaning, the ‘average’ health plan one year can become a ‘below average’ health plan the next by simply standing still. To maintain and improve NCQA ratings, health plans must be relentless in their quality improvement activities.

Like all public reviews from a trusted source, a health plan’s NCQA score impacts purchasing decisions by:

  • Employers and employer groups
  • Brokers and consultants
  • Consumers (increasingly important as employers shift more cost to employees via high deductible plans)

HEDIS® reporting and NCQA rankings create a competitive advantage or disadvantage. To boost quality ratings to attract and maintain consumers across every market segment, health plans must be strategic in their approach to improving the delivery of preventive services, managing acute and chronic conditions, and controlling utilization.

At its core, improving HEDIS® scores means understanding and addressing the root causes of care gaps. Gaps exist and persist for a variety of reasons. A new white paper from Geneia explores root causes stemming from:

  • Organizational barriers
  • Provider relations
  • Member engagement

Traditional approaches to HEDIS® improvement activities are no longer enough. With a focus on succeeding within value-based arrangements, health plans and their provider networks are coming into alignment around the importance of delivering and reporting identified services. Today, a deep level of collaboration is required and achieved through technology, transparency, reliable data and education.

Download our new white paper to learn more about improving your NCQA health plan ratings and accreditation through a proven approach to understanding root causes of, and closing HEDIS® related care gaps.


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