2018 HEDIS season is closer than you think: 6 actions to take now to be ready

HEDIS 2018 season is right around the corner! Are you ready to learn from your 2017 programs and build metrics based 2018 quality improvement programs that deliver improved results across some 81 measures and 5 domains of care? Here are six actionable items quality managers can take right now to be ready to roll in January.

Conduct a HEDIS 2017 project post-mortem
Health plans likely completed a recap immediately following the HEDIS 2017 season, but now is a good time to reconvene a small of group stakeholders to discuss what worked well and what didn’t in the context of preparing for HEDIS 2018.

It’s particularly important to discuss challenges and opportunities related to vendor strategies and utilization. If there is any need to replace a vendor, seek additional vendor services, or restructure vendor agreements, it’s imperative to begin that work now, if it has not already been done.

Re-engage with established HEDIS vendor partnerships
Begin to set vendor expectations for the upcoming HEDIS Medical Record Review project. For example, if a chart retrieval vendor was used, did the vendor meet targets for the percentage of charts returned? How many vendor-assigned charts were returned during the final two weeks of the HEDIS project? Set targets and expectations that promote higher return rates earlier in the project.

Clean-up your provider data
Accurate provider data is crucial for a successful HEDIS project. Take time to ensure you have the most up-to-date contact and location information for providers. Remember, the location of the medical record is not always the practice location. Provider data for HEDIS MRR should be indicative of the best avenue for retrieving medical records.

Account for changes that may have happened since last HEDIS season, such as formerly independent physicians now aligned with health systems, which may have different methods for requesting medical records.

Review prior year communication materials and strategies
Identify ways to improve and streamline provider requests and communications. Provide clear instructions on what is needed from the patient chart, deadlines for returning records, and who to contact for questions. If possible, get provider office staff input on the clarity of your communications.

Stratify provider groups requiring special protocols
Flag groups with special contractual arrangements with the health plan. For instance, groups with care coordination or similar agreements may benefit from specialized HEDIS strategies.

Also begin flagging groups that may need dedicated vendor support vs those that will be handled internally, such as provider groups with embedded health plan resources.

Engage internal teams early
Begin preparing and setting expectations for the upcoming HEDIS project with internal stakeholders across departments, particularly for new employees. By December, key market resources should be identified, and all stakeholders should be aware of the approaching project and their role in its success.
Schedule training sessions. Teams will likely benefit from a refresher on HEDIS MRR vernacular, HEDIS software, etc.

About the author
Alvonice Spencer, MSHA, is director of quality for Pursuant Health. Pursuant Health’s multi-channel population health platform conveniently meets health plan members where they are, capturing and integrating health-related data to incentivize healthy behavior.

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.

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