Stay ahead of HEDIS updates to maximize your quality improvement efforts

Insights from Quality Advisory Services within Optum Advisory Services

Managing a Healthcare Effectiveness Data and Information Set (HEDIS®) program is not a one-time exercise. With yearly updates coming from the National Committee for Quality Assurance (NCQA), it requires your HEDIS management program to evolve and morph; you continue to use what works and refine and hone what doesn’t.

One of the key factors to success with yearly HEDIS updates is to make sure they are integrated as quickly as possible into your prospective reporting.

HEDIS quality measure updates for 2019
Major updates to the 2019 Star-related HEDIS measures were announced in the NCQA release of draft technical specifications in July 2018. Among the many updates, the two that impact health plans most are:

  1. Complete redesign of Controlling High Blood Pressure (CBP) measure
  2. Added exclusions for Medicare members with advanced illness and frailty

Additional impacted HEDIS measures are:

  • Rheumatoid Arthritis (ART)
  • Breast Cancer Screening (BCS)
  • Colorectal Cancer Screening (COL)
  • Comprehensive Diabetes Care (CDC)
  • Caring for Older Adults (COA)
  • Osteoporosis Management in Women Who Had a Fracture (OMW)

How these updates impact health plans
Since some of these updates affect eligible populations, the impact to health plans is large. Preliminary analysis shows up to a 20 percent change in eligible populations for some measures and rate variances for up to 10 percent. Since final specifications are not finalized and released until October, HEDIS-certified engines will not have the updates implemented in time to inform your fourth-quarter outreach activities.

So, how do you shift outreach efforts to be accurate and successful?

Take action now to ensure accurate member targeting for fourth-quarter gap closure activities
Health plans need to apply this update now so they are better prepared to capture accurate rates for HEDIS in 2019. To be prepared for spring submissions, your outreach and prospective activities need to be augmented to account for these changes as soon as possible.

A time-sensitive solution
You may receive actionable data well before your certified engines are updated. Your resources can optimize their time by focusing efforts on targeting the appropriate populations. Predictive insight helps support more accurate targeting and gap closure activity to avoid missed opportunities. This means increased accuracy for ongoing prospective reporting.

To learn more how you can take action now to prepare for 2019 HEDIS updates, click request more information.


About the author:

Mallory Van Horn is the Quality Practice lead for Optum Advisory Services. The Quality practice focuses on assessing, designing, implementing, and launching quality improvement and quality management and performance business solutions for commercial, Medicare and Medicaid products. Mallory’s area of expertise includes HEDIS, CAHPS, Star Ratings and accreditation with a particular focus on clinical quality measurement and reporting, state regulatory quality reporting requirements, administrative data improvement strategies and compliance audits.

Mallory has over 20 years of health care management experience and has been managing HEDIS operations and reporting for about 15 years, focused primarily on government products such as Medicare and Medicaid.

Prior to joining Optum, Mallory served as the National HEDIS Director for UnitedHealthcare Community and State. In that role, she had accountability for over 80 HEDIS® and CAHPS submissions on an annual basis. In addition, Mallory served as the Manager of Informatics Consulting for APS Healthcare, where she oversaw quality data analysis initiatives for both the Oklahoma and Florida state Medicaid programs.

*HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).


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