Just as accountants have likely had their fill of tax forms by April 15, so too has your team probably tired of medical records by June 30.

But whether it is tax season or HEDIS reporting season, the sooner—and smarter—you start your off-season the stronger your performance will be in the next year. Your team will be better prepared if you assess what went right and what went wrong in the past, and adjust for the future while the lessons you learned are still fresh in your minds. Doing so will help you achieve compliance and submit your next HEDIS project on time for all lines of business in order to ensure successful outcomes.

Here are five things you can do in the off-season to improve your HEDIS scores—and the quality of care.

1) Convene and converse

Don’t wait until December. Discuss changes for the next reporting season as soon as you submit your data for this year. Get your team together in late June or early July to discuss lessons learned while they are still fresh.  This will serve as a kickoff for your overall off-season improvement plan.  

2) Identify gaps

Where were the obstacles in this year’s medical record review (MRR)?  And were they bumps in the road or roadblocks that forced costly detours? If certain providers didn’t respond promptly, perhaps some personal follow-up will make them more cooperative. If incompatibility in electronic medical records hindered your MRR efforts, explore technology solutions. Whatever the gap, close it so that you can improve your HEDIS scores.

3)  Review charts

Leverage risk adjustment charts by reviewing them for gaps in care that you can remediate and as well as for potential exclusions for both hybrid and administrative-only measures. You can use Reveleer’s STARs Improvement to do this as well as to gather additional charts that could allow you to impact hybrid and administrative measures such as Adult BMI Assessment, Comprehensive Diabetes Care - Eye Exam and Breast Cancer Screening.   

4) Tune-up technology

From verifying the certification of your HEDIS-certified software vendor to testing all of its interfaces with your MRR vendor, confirm that you are ready to quickly process accurate data. Implementing, testing and remediating any changes before mid-December is ideal.

5) Communicate

Create a plan that covers when and how you will communicate with stakeholders, including vendors, providers and members. Clarify deadlines, roles and expectations well in advance of January so that you can start strong.

Proactively and efficiently retrieving relevant medical records and abstracting them quickly and accurately are essential for successfully completing HEDIS MRR projects. And, your data collection and analysis will be more accurate if you complete key steps like planning, benchmarking, configuration and setup well in advance of loading data. So, work sooner and smarter in the off-season to improve your HEDIS scores.

About The Author

Mike Curran is VP of Quality/HEDIS for Reveleer. He has worked in Managed Care for 25 years and brings extensive management and operations experience to Reveleer, as well as proven ability to build high performing, results-focused teams. Prior to joining Reveleer, he came from United Healthcare where he was the National Director for Clinical Performance Improvement. Mike is a graduate of St. Anselm College where he earned a degree in Politics and Boston University where he earned his Master of Public Health degree.