As we are making our final preparations for the 2014 HEDIS® season, most of us have undoubtedly taken care of the big ticket items related to HEDIS® preparation, such as—vendor selection and performance guarantees, development of measure chase logic, and notifying the network of the upcoming intrusion. There are, however, some less obvious actions that a plan can take in preparation for the upcoming HEDIS® season that can make a big difference in HEDIS® rates.

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  1. Don’t get caught with unusable supplemental data. Rules for using supplemental data have tightened up for 2014. This means everyone needs to take extra care to make sure their supplemental data is auditable, has a documented QA process around it, that it’s collected in a standard way, and is mapped correctly into analysis files.
  2. Don’t be without network management support from provider relations. Avoid wasting time trying to get into resistant provider offices by articulating a clear strategy for engaging the network team to assist in gaining access.
  3. Carefully review your provider data when your chase files are generated. Take special care to scrub out specialties or locations that do not make sense for the measure. This will save you time and money, and allow you to focus limited resources on more fruitful activities.
  4. Inspect your lab data. There are critical flags that can help you quickly identify if you may be missing information. For example: what percentage of tests are for A1c and LDLs, and are they consistent?
  5. Provide your vendors with as much information as possible regarding your past performance on hybrid measures and what your goals are for 2014. This will help your vendors immediately see the delta between the goal and initial hybrid rates, and allow them to employ appropriate prioritization and retrieval strategies throughout the project.

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.