With HEDIS Medical Record Review (MRR) season right around the corner, there are still things you can do to help create a successful season. In this post, we’ll focus on a few key activities that can be done in January to assist the upcoming HEDIS MRR season.
A best practice to support a sucessful HEDIS MRR season is to map your glide path goals week by week.
Define your goal rate per measure numerator. Then project where your rates should be each week in order to achieve goal. Evaluate your glide path throughout the season to determine if you’re tracking. If possible, include your historic week-to-week trends. Ideally, your glide path should include milestones that identify how you’re progressing in core work streams. Track scheduling, retrieval, abstraction, and over-read to confirm they are on plan.
Be prepared to drill through to the next level should problems arise. For example, if the volume of records retrieved isn’t trending, be prepared to drill into your high-volume locations and high-priority measures. Consider what questions will be asked if a work stream isn’t trending and prepare metrics to assist in investigating. (See a glide path example below.)
For a smooth HEDIS MRR season, train field staff and abstractors in the technology as close as possible to production. This allows optimal time to prepare materials and ensures teams get information close to when they’ll be using it. In a fast-paced MRR season, good training helps standardize operations and minimize confusion. Here are some best practices for training:
- Include lessons learned from previous seasons in your current training.
- Train abstraction and retrieval staff on measure logic and acceptable documentation.
- Highlight and spend sufficient time on measures that have changed this season.
- Define escalation paths for medical records that you aren’t certain about: Outline processes for who reviews questionable records, when to enlist an external auditor, and how responses are disseminated to the team. Defining these processes proactively limits confusion and missed opportunities in the season.
- Communicate your glide paths to staff and make everyone aware of goals. Shared expectations and frequent updates on progress creates a unified vision and maintains the excitement. Nothing creates momentum like a shared vision!
With a shared vision and an eye on execution, your HEDIS season will be effective and — dare I say — enjoyable. So now’s the time to create a glide path to success, and make sure your staff is well trained and prepared.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
About the Author:
As director of Clinical and Quality Solutions at Optum, Cybil Fry partners with health plans to improve their HEDIS scores. Prior to joining Optum, Cybil spent significant time leading HEDIS efforts for health plans. She first worked in data analytics with a focus on accreditation. She later led HEDIS/Stars reporting and initiatives. She had the pleasure of conducting end-to-end HEDIS across all lines of business and accomplishing year-over-year improvements. Cybil also led a team that consistently met all Medicare Stars goals each year. After achieving her HEDIS goals as a health plan employee, Cybil moved to Optum to help clients achieve their HEDIS and Stars goals. She recognizes “the purpose of quality reporting is quality improvement,” and focuses her sights on developing innovative means to project and improve HEDIS outcomes.
Cybil holds a BA in Information Systems and has an extensive background in trend analysis.