Five ways health plans can set themselves and their value-based partners up for success in 2020.
Health Plans

How to engage providers for HEDIS success in 2020

March 19, 2020
Five ways health plans can set themselves and their value-based partners up for success in 2020.
Chief Executive Officer, Retired

As the first quarter of 2020 comes to a close, health plan quality teams are in full swing to meet June reporting deadlines. Pressure has shifted from providers to close gaps in care to health plans to demonstrate gaps were closed.

Even though quality teams are stretched thin, now is the ideal time for health plans to actively engage providers and prepare for a successful 2020. We know – engaging providers in HEDIS® improvement is hard.

Here are five things to consider that, if done properly, will help set you and your network up for improved reporting and higher scores.

One: Understand the provider perspective.

On the surface, this seems like a given. However, successful engagement strategies are built upon understanding motivations, needs, strengths and weaknesses of those you wish to engage. Unlike health plans, many providers struggle to see the connection between their role in HEDIS® reporting and providing excellent patient care and patient experience – to them, it’s an overwhelming burden that gets in the way of their “real” work of caring for patients. To compound the burden, providers are flooded with payer, government and technology “partners” trying to prioritize their work for them.

To break through all that noise and become a trusted advisor, health plans must demonstrate an understanding of their pain points and help them connect the dots between what you are asking them to do and the value it brings to them.

Two: Get their attention through clearly defined incentives.

Like health plans, providers want to get paid for extra work asked of them. Health plans with high HEDIS® scores and Medicare Star ratings tend to focus efforts on HEDIS® measures that deliver the maximum reimbursement. Likewise, those reimbursements roll down as network incentives for providers.

The trick is, however, to make it easy for providers to understand and be successful in their value-based contracts with you. To many providers, these incentives feel like HEDIS® hocus-pocus and are not worth their time and effort. Make it worth their while. Set clear expectations. Make it easy for them to understand their progress toward achieving targets. Make it even easier for them to get help from your population health experts.

Three: Improve compliance through measure alignment.

Providers are more likely to follow clinical suggestions that impact significant portions of their patients. When payers align around common measures, it is easier for providers to comply. Health plans who identify these easy targets improve their chances for better quality scores.

By way of example, for HEDIS® 2019, NCQA changed the standard across all ages for Controlling High Blood Pressure to <140/90 mm Hg. This is the same as the standard for Medicare MIPS. Because blood pressure is easy to capture, compile and report, many MIPS providers are using this metric as one of their required MIPS outcome measures.

Understanding and aligning around this type of metric is a solid win for health plans looking to improve and simplify HEDIS® in 2020.

Four: Providers need time to adapt.

With often limited resources and hectic schedules, providers tend to focus on the tasks at hand over tasks for later in the year. Additionally, it can take months for their EHR vendors to update systems to reflect reporting changes. Health plans can demonstrate an understanding of these constraints by setting realistic timelines and sharing technologies to shorten lead time. Health plans have tremendous access and experience with sophisticated technologies and reporting solutions. Bearing in mind that providers do not have the same history and access is important to understanding the provider perspective.

Health plans with top HEDIS® scores and Medicare Star ratings do more than send out an email with HEDIS® measure changes and lists of patients with care gaps – they deliver integrated technologies and reporting solutions to make it easier for their provider networks to succeed.

Five: Show them the data.

Like health plans, providers appreciate specific, data-driven information to inspire and drive lasting change. Sweeping “improve quality and lower costs” statements are not inspiring. Share specific projections around how specific measure changes will improve patient care. Similarly, health plans can improve engagement by sharing actual, detailed cost projections for the immediate and near future.