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Tips for Your Next HEDIS Season

September 12, 2016

Another HEDIS® season has been completed. With 65% of the nation’s clinical and quality outcomes measurement analytics using Inovalon’s platforms, we have analyzed our clients’ results to share some of the best practices and key lessons learned this season to help you prepare for the 2017 HEDIS® submission.

Understand Your Data

The results of your data are only as good as the data you load. Review the NCQA Technical or State Measure Specifications to make sure all required data elements can be transitioned from your source data to meet measure specifications.

  • Verify that you have data from all required sources. Conduct an audit or evaluation of your data streams.
  • Analyze the data for completeness.
  • Run frequency reports to ensure you have all data expected for the measurement period, assessing for gaps in dates of service.
  • Analyze the data variables to identify data inconsistencies or non-standard coding practices.
  • Work with your auditor on use of non-standard codes for rate production.
  • Make sure you validate customization of homegrown codes.
  • Appropriately define populations (i.e., Commercial ACA, Medicare, Medicaid, etc.).

Streamline the MRR Process

A streamlined Medical Record Review (MRR) process starts with identifying the correct physician locations that maintain the member’s medical record information, as well as identifying physicians who should not be included in the MRR process. This process should also include a test of your hybrid pursuit logic and an assessment of whether you can collect data through EHR interoperability, as well as obtaining EHR access for abstractors. Finally, ensure that all physician contact information, including telephone and fax numbers, is up to date.

Remember Your Documentation

Your quality team’s 2016 issue log is one of the best tools for leveraging opportunities for improvement based on prior HEDIS® seasons. You can use the log to define best practices and to include all necessary enhancements are included in the current year’s project plan. Similarly, you should reference your organization’s prior year roadmap to identify changes in any internal processes that could impact your upcoming HEDIS® season. Engaging with your audit firm early is the best way to prepare for the 2017 audit and measure production.

Armed with effective strategies, comprehensive analytics and access to robust data sets, your organization will be positioned for success during the upcoming HEDIS® season. To learn how you can further your quality program goals, listen to our webinar, Quality Reporting & Improvement Strategies for Success.

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