Blog #2 in a 2-Part Series
In part 1 of this blog series, I made the case for taking a year-round approach to improve HEDIS season efficiency. Here, I offer the framework for a tool to jumpstart your success.
Maintain momentum quarter after quarter with a HEDIS calendar
Create your calendar by documenting events and deadlines from both HEDIS years concurrently, along with activities to address both. Use the questions below, according to each quarter, to help guide your strategy.
Quarter 1: Think “out with the old, in with the new”
As the collection period for the previous year comes to a close, direct your attention on the new year. Seek to understand:
- How are you getting members in to see their providers?
- Does your technology allow for view into both years simultaneously?
- What reporting are you using to effectively engage providers during this limbo time with limited gap data?
- How are you engaging members that failed last year?
Did You Know?
That providers familiar with quality programs will often request a list of members to outreach. In the absence of gap data, a “Failed Member List” from the previous year is often a great place to start in the New Year.
Quarter 2: Balance “Wrap up” with “ramp-up”
Although a lot of energy and resources are needed to close out chart chase, gap closure data for the current year should now be available and needs to be distributed. Ask and answer:
- What are you doing to outreach providers and members?
- What is your strategy for gap closure, tracking and reporting?
- Is your prospective vendor/data partner ready?
- Do you have a process in place to verify that measure changes are fully accounted for? This includes:
– Multi-year measures
– Measure changes (such as age range, etc.)
– New measures
– Accurately representing exclusion (new or old) criteria
Quarter 3: Celebrate but get right back to work on closing gaps
Even though chart chase is over, now is not the time to rest. At this point you should have a robust set of data for the current year, with several months of reporting completed. Focus your action now by determining the following:
- How could you make your provider reporting even better?
- What is your provider engagement strategy?
- How are you handling incomplete/missing data rework?
- Are you reshaping your focus according to your data?
Did You Know?
That if the provider is provided with “real time” reporting on missing information that success in closing gaps is significantly increased.
Quarter 4: Flex and evolve based on what the data tells you
As the opportunity for reporting Admin-Only measures comes to a close, it’s essential that you use your resources wisely to determine which gaps to impact in time:
- Do you have a fourth quarter push strategy in place?
- Does your reporting support your strategy?
- Are you focused on the right things and does your data reflect that?
Did You Know?
If your system cannot accept supplemental data that you are missing out on gap closure.
To take your HEDIS strategy (and results) to the next level, recognize that HEDIS is more than a season: it’s a year-round mindset. You have to combine the solid processes and good data to feed chart chase with the right activities year round to maximize your success.
Put simply: The more preparation you do on the front-end, the better your results on the back-end. Preparation means having the right technology, data and expertise to drive effective engagement, documentation and reporting all year long.
To learn more, request a demonstration of HEDIS tools
About the Author:
Michelle Swanford, MHM, MSW, LCSW
Director of Clinical & Quality Solutions, Optum
Michelle has spent nearly 20 years in the health care industry, with the past 8 years dedicated to solutions and strategic leadership in the Quality space. She has 13 years of experience working for payers in both the Medicare and Medicaid programs. She currently develops innovative solutions for payers in the areas of Risk and Quality. Michelle has a Master of Social Work from Tulane University, as well as a Master of Health Care Management from University of New Orleans.