Keys to managing the top 10 HEDIS challenges

A health plan’s Star Ratings and bottom-line performance depend heavily on improvements made to quality measures and Healthcare Effectiveness Data and Information Set (HEDIS®) scores. The key to boosting HEDIS scores and gaining competitive advantage is to be proactive and meet its challenges head on.

But what exactly does that mean? We’ve identified the top 10 HEDIS challenges and strategies to successfully manage them.

  1. Find adequate time and resources. With multiple HEDIS deadlines to meet throughout the year, having the right people and processes in place is critical.
  2. Stay motivated for year-round preparation. HEDIS doesn’t have an off-season so a post-season review can help determine any strategies you may need to meet challenges or barriers in the upcoming year.
  3. Have a robust alternate plan. A robust plan is critical to keep everyone on track with HEDIS strategies. But just as important is having a “plan B” to fall back on so you can adapt, adjust and pivot when needed.
  4. Conduct mock audits. While not always popular, mock audits reduce the potential audit pitfalls through proper preparation and lower the number of audit follow-up issues and requests, and can reduce the amount of post-audit follow-up.
  5. Maintain patient-level detail (PLD) accuracy. You may not get everything right in the beginning, but when PLD errors are found you need to go back, research and fix them.hedis-blog-image
  6. Strategically plan for medical records review validation. Additional staff and increased training can help you plan and successfully pass your Medical Record Review Validation (MRRV). Remember, you should manage your MRRV — don’t let MRRV manage you.
  7. Use administrative supplemental databases strategically. If you have multiple supplemental databases, it’s important to prioritize by volume and impact to allow your auditor enough time to get through all of the PSV audits.
  8. Build on the year’s experience. When the year is completed, look for the hidden gems in the data you collected and conduct a broader chart review.
  9. Invest in resources that will increase your agility. Being successful means being more nimble. Make sure you have the proper tools and dashboards to provide line of sight into daily performance and progress toward goals.
  10. Keep up your momentum. Remember, HEDIS success is a marathon, not a sprint. Acknowledge contributions along the way, celebrate the small milestones, and ask for help when you need it.

For more insight read “Best practices for HEDIS rate improvement” or view our webinar.

Mallory Van Horn, MPH, MBA
Sr. Director, Consulting, Optum

Mallory Van Horn leads the Quality consulting practice for Optum. She has 15 years of health care experience, focused on assessing, designing, implementing, and launching Quality Improvement and Quality Management and Performance business solutions for the payer and provider market.

Mallory’s area of expertise includes HEDIS® and Stars with a particular focus on clinical quality measurement and reporting, state regulatory clinical quality reporting requirements, and administrative data improvement strategies.

Leave a Reply