There are many ways to measurably improve HEDIS rates and the quality of care of members. The true challenge is navigating the various barriers that can delay your journey to get there.
Without a doubt, collaboration is the difference between higher and lower HEDIS rates. The more effective the collaboration — and integration — the better the rates. In fact, the payers most successful in achieving consistent HEDIS rate improvement are the ones who have identified strategic collaboration and program integration initiatives that align their risk and quality programs.
Greater collaboration starts with these five points:
- Align with other areas within your organization. Look at those groups that could have the most influence if they were part of your collaboration strategy.
- Engage providers and members by maximizing downstream analytics and reporting. Align your executives, operational teams, provider and member engagement teams by providing access to quality data that will help them better focus their efforts. You’ll find that sharing data and information helps you build better roadmaps for provider and member engagements.
- Work across teams to explore integration opportunities. Identify opportunities to encourage cross-functional collaboration. For example, programs that use data beyond HEDIS submissions could utilize cross-functional sharing for more beneficial results.
- Leverage data from your providers and EMR systems. Electronic data acquisition through electronic medical records (EMR) is a must-have if you want to improve HEDIS rates. If you have the ability to work with your provider network, associated EMR system or a trusted vendor, setting up a direct connection to EMR will help you acquire data more efficiently than manual chart review.
- Share data and charts through a centralized repository. A centralized analytics and reporting system can help you aggregate data from multiple programs, even outside risk data such as utilization. All can help identify and close gaps, and deliver significant dollars back to your organization. chart reviews can help you build better roadmaps for provider and member engagements.
Achieving improved HEDIS rates doesn’t happen in a vacuum. Collaborate with those within your organization, as well as trusted external partners, and improved rates and quality of care will follow.
For an extended discussion on the five best strategies of collaboration, please download our white paper, “HEDIS rating improvements: Best-practice strategies.”
About the author
Sam Diederich is a Director of Risk & Quality Strategy for Optum and has been responsible for the Quality programs offered to Payers by Optum for the past 3 years. He has earned degrees in Finance and Economics from the University of St. Thomas in St. Paul, MN. Within his Risk & Quality Strategy role, Sam is focusing time on Risk programs for both Medicare and Commercial payers, as well as assisting Payers with Risk and Quality program and strategy alignment.