HEDIS® Consulting

HEDIS® Consulting

HEDIS® Operations Management

With staff that have 25+ years of HEDIS® experience, we are uniquely positioned to provide HEDIS® staff augmentation that will help you raise rates, reduce stress, and ensure success!

  • Experience across with over 10 HEDIS® Certified and Abstraction vendors
  • Led HEDIS® operations at small and large health plans
  • Managed over a dozen vendor migration project to new HEDIS® certified vendors
  • Assistance in managing overall strategic operations to the minute details of final submissions to CMS and NCQA

We can manage the requirements of your HEDIS® season from start to finish or work aside key internal team members in an advisory and operational role.

 

HEDIS® Assessment

We can provide HEDIS® assessments of your entire HEDIS® operations. These assessments include a thorough review of the following areas.

  • Roadmap and Audit Support
  • Vendor software implementation
  • Vendor management
  • Training of chart review staff
  • Data extraction, analysis, & reporting
  • Dashboarding
  • Off-season work items
  • Quality Interventions/Gap Closures

 

Organization

HEDIS® should become an Enterprise wide program. We will assess that and help guide your health plan through a series of steps to make sure everyone in the organization understands how they contribute to a successful HEDIS® program.

  • Network Teams

Provider-plan relationships are important for hybrid medical record review and establishing strong sources of supplemental clinical data. Understanding the structure of your provider network and identifying weaknesses that impact quality rates is integral in building a strong foundation for HEDIS®.

  • Quality Team

Managing QI initiatives and quality programs are only a small piece to successful HEDIS® rates. The Quality team is the brain center that works on HEDIS® and is the primary responsible entity to a smooth and efficient season and improved rates.

  • Reporting Requirements

Reporting is the key factor in a successful HEDIS® seasons. Intuitive dashboards, with strong goal setting capabilities. Metrics on key performance indicators are mandatory in order to improve HEDIS® rates year after year

  • Software and Vendors

Whether you contract with outside vendors for rate calculation and chart chase or do everything in-house, there are always ways to improve data sharing and outcomes.

  • Vendor Assessment

The software your plan uses to calculate quality rates is at the heart of the HEDIS® season. Challenging and complicated layouts can pose problems as well as deficiencies in reporting and tracking capabilities.

  • Medical Record Review Strategy

Every step from chart chase generation to successful MRRV is vital in retrieving a high volume of charts and finding every hybrid hit possible. Often, MRR hits are left on the table and incentive payments are consequently missed.

 

Data and Process

HEDIS® rates are only as good as the data that feeds them and the processes that bring the data to the quality engine.

  • Data Inventory

Gaining a full understanding of every piece of data that feeds HEDIS® measures allows you to see what you may be missing and what can be improved.

  • Systems Survey

Analyzing the strengths and weaknesses of the data systems that feed HEDIS® rates (claims systems, data warehousing etc.) allows you to improve data quality and data flow for the purposes of quality reporting.

  • Compliance

The HEDIS® Audit, starting with the Roadmap and ending with submission lock, is a long and rigorous process that highlights inefficiencies and areas to improve

 

HEDIS® Improvement Services

Improve Quality and Enhance Performance Measurement

We bring proven expertise in assessing the effectiveness and efficiency of HEDIS® programs and helping plans understand and improve their performance. Health plans can rely on our expert management and/or outsourcing services to improve or maintain any type of quality rating (STAR’s, State programs), Accreditation, and provider incentive payment strategies.

 

Professional Consulting Services

Our performance measurement practice offerings range from complete HEDIS® program management to strategies targeting individual metrics. Our services cover:

  • New plans wanting to build a baseline
  • Established plans with maintenance goals
  • Any plan with improvement goals

Improve Rates

To ensure accurate measurement, data should never be left on the table. We offer:

  • Data extraction, analysis and reporting
  • Implliementation of vendor software
  • Supplemental data sources (new sources and validation of existing sources)
  • Management of chart vendor
  • Roadmap and audit support
  • Measure rate validation and troubleshooting
  • Identification and integration of supplemental data sources
  • CAHPS scores review and analysis and systematic methodologies for improvement

 

Enhance Efficiency in Measurement

Services to improve efficiency, accuracy and yield of chart review include:

  • Prioritization and management of review and audit processes
  • Logic to determine chart location
  • Chart review verification and over-read
  • Training of HEDIS® review staff
  • Selection and/or management of HEDIS® certified and Chart Review vendors
  • Validation, reconciliation, and integration of HEDIS® findings
  • Creation of care registries
  • Provider and member segmentation
  • Analysis of gaps in care
  • Development of P4P criteria

Star Ratings Program Services

Our STAR’s Program offers Medicare Advantage Plans a fully integrated action solution that helps plans meet quality-based objectives. Our program provides an opportunity to maintain or reach a 4 or 5-Star rating required to secure the millions available to health plans from CMS. We will assess your current STAR program, culture and provide subject matter expertise coupled with intuitive Dashboard’s historical and prospective data-driven performance metric tools, geared towards overall STAR improvement levels. Our goal is to make you experts in STAR ratings and processes, improving and ensuring the highest quality healthcare for your membership, resulting in the premium STAR ratings and an increased opportunity for higher revenue.

Strategies include

  • Communicate With Beneficiaries
  • Listen To The Beneficiary’s Voice
  • Incremental Outreach
    • HEDIS® Measures
    • CAHPS Scores
    • HOS Measures
    • Prescription Drug Event Data
    • Other Data
  • Support Providers
  • Support Office Staff>
  • Think Big Picture
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