An expert viewpoint: Why HEDIS is a marathon, not a sprint

Blog #1 in a 2-Part Series

You may think of HEDIS season as a point-in-time push where you focus significant resources on getting the documentation you need to show that members received their necessary treatments, screenings and more. Likely that effort consumes your priorities, starting with the January prep through the June submissions. But your HEDIS efforts are shortchanged by taking this seasonal-sprint mindset.

The more you do year-round to close gaps in care, and the more you focus on documentation and reporting year-round, the more successful your year-end HEDIS results will be.

This blog series discusses the activities that can be done throughout the year to improve HEDIS season efficiency.

What’s the value in taking a year-round approach?

Every HEDIS gap you close during the year—prior to chart chasing—results in one less chase for hybrids. This enables your organization to focus on the harder-to-find HEDIS measures during chart chase.  The result? Improved resource utilization and increased gap closure.

The key is to use the same energy getting the member in to be seen by the provider between January and December, as you do getting member results February through May.
Get started with these actions.

Even as you finish one year, focus on what you want to achieve in the next. Here’s how:

  • Evaluate your strategy for getting the results both in and documented correctly. This means working proactively with providers to get members for their needed treatments or screenings/tests along with proper documentation and coding throughout the year.  No treatment or test means no documentation and no gap closure.  Or even if there is a treatment or test: poor documentation can mean no gap closure.
  • Determine how to best get the timely and accurate prospective reporting you need to identify what’s missing or incomplete. This is your roadmap to guide you in what to pursue. If you wait until chart chase, your window of opportunity is already closed.

In the second part of this blog series, I’ll provide inputs for a quarterly calendar, helping you plan and track your activities year round. Don’t want to wait? Get it now.

What is your strategy for identifying the right year-round activities to maximize your HEDIS success? Connect with Optum to talk with an expert.

Learn more with these resources.

Request a demonstration of HEDIS tools

About the Author:

Michelle Swanford headshot_060418.docx

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.

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