Background
Health Services for Children with Special Needs (HSCSN) serves children and young adults up to age 26 who live in Washington, D.C., and receive Supplemental Security Income (SSI). The health plan focuses on young people with special healthcare needs, supporting them and their families with the appropriate level of care to make their life as full as possible.
As a smaller health plan serving roughly 5,000 members, HSCSN has unique quality reporting challenges. Just a few members’ care or conditions can make a difference on measure performance, and the District of Columbia expects a 3% year-over-year improvement on quality measures.
Still, HSCSN must meet HEDIS® reporting requirements – which is where Converged Quality comes in. Inovalon’s quality measurement software makes all the difference for HSCSN’s team, giving them the data access, analytics, and clarity they need to close care gaps and navigate quality reporting.
<26 years of age
Washington, D.C. residents
SSI recipients
From Learning HEDIS to Managing Reporting Season With Ease
When HSCSN’s HEDIS Manager, Davina Green, first made the shift from a care coordinator to the quality measurement team, she wasn’t familiar with HEDIS. She shares, “Inovalon helped me lean in and understand what was required. They said, ‘We’ll come to you, we’ll present, we’ll help you learn the ropes.’”
That hands-on partnership set up HSCSN for success during HEDIS season. Working closely with Green, Inovalon’s product team stepped up to help Green ingest data, load it, run the analytics, download exports, and ultimately, make sense of what their member data was telling them.
Today, monthly measure rate reports help Green and her team understand and improve performance on key measures, meet state, federal and auditor deadlines, and proactively prepare for HEDIS season. Inovalon’s quality measurement analytics also enable HSCSN to better manage member care programs, such as disease management.
Monthly measure rate reports help HSCSN:
- Understand and improve the success of certain benefits programs
- Track performance on key measures, such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT), Well-Child Visits (WCV), and Follow-Up After Hospitalization for Mental Illness (FUH/FUM)
- Meet state and federal deadlines
- Meet auditor deadlines and deliver custom audit reports
- Be proactively prepared for HEDIS season by knowing where they land on performance goals year-round
Connecting Data to Care Coordination
HSCSN’s disease management strategy is centered on two pillars: data analytics and engaging their care managers. Data pulled from Inovalon solutions helps the health plan customize care gap lists to include the care manager’s name for each enrollment, as well as heat mapping that highlights areas of focus with detail on measures and populations to focus on.
This turns massive amounts of member data into clear next steps for care coordinators. They can easily see care gaps and understand what’s needed to address member needs – and go into member encounters with enough information to make a personalized connection. This data-driven workflow enables the team with the data they need to go and engage members with unique care needs.
NCQA Rating Success
Inovalon’s quality measurement software has transformed HSCSN’s quality strategy from spreadsheet-based, stressful reporting to data-driven, streamlined work.
Green sums up her experience as, “You can really lean on Inovalon; it’s always been a collaborative effort. In the past, there would have never been a day I would have taken off during HEDIS season – now I know I can step away for a day or two and everything will be okay.”
Plus, NCQA’s Health Plan Ratings reflect this with a star rating system that is based on quality (HEDIS) and member experience (CAHPS) scores. Last year, HSCSN went up a half a star rating, from 2.5 to 3 stars. They continue to rely on Inovalon as their quality measurement strategy improves further.
NCQA Health Plan rating improvement
- Top 25 health plans based on AIS List of Top U.S. Payers, 2022. Inovalon internal reporting. April 2024
- Inovalon calculation based on HEDIS® MY2022 data. September 2023.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
Inovalon and design® and Inovalon® are trademarks of Inovalon, Inc.
