HEDIS-gap-analysis

With HEDIS® 2014 completed, now is the time to start planning for HEDIS® 2015. While the active medical record collection period is short, HEDIS® is a year round activity. There are many opportunities that can be acted on now to make next results even better for many it’s a matter of data gaps and identifying where those gaps exist and taking action to close them can drastically improve your HEDIS and STARs rates next year.


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CLOSING THE GAPS

Reviewing HEDIS® 2014 results with claims data throughout the year can give you an insight into where data gaps with quality of care measures that impact HEDIS® and STARs results. When analyzing this information, you can identify interventions for your health plans, providers and members. It is important to prioritize interventions by the impact they can yield.
For health plans, consider what is driving your gaps.

  • Are gaps resulting from network leakage due to members visiting providers that are not participating with the plan and aren’t obligated to provide medical record information? If so, work with your benefits department to identify ways to message members about in-network benefits.
  • Are there large provider groups that are resistant to cooperating? 
  • Do they have EMR? What incentives can you provide to encourage participation?

Engage provider network management to find ways to work with challenging provider groups now to make HEDIS® 2015 smoother. Are there other supplemental data sources that can help improve rates.  For example, investigate state registries for immunizations.

Provider engagement is another key way to improve HEDIS® 2015 and Stars results. Providers are challenged with day-to-day operations of their offices and may not have the resources available to identify members needing preventative screenings or chronic care management. Targeted reports providing them with up-to-date patient information can assist them in their outreach efforts to encourage members to receive timely care. In addition, identify ways to offer providers options for HEDIS® 2015 that can reduce provider intrusion. Do they have EMR that can be accessed remotely? Do they want to schedule early so they can anticipate and schedule your HEDIS requests with other plans? Sometimes it’s the little things that make the provider’s life easier that can help with getting the responsiveness you need for your HEDIS® data collection.

The health care system is challenging to navigate. By making it easier to understand, members can become more engaged in managing their health. Depending on your membership demographics some outreach efforts are more effective than others. Consider a multi-prong approach such as mailings, voicemail and health educator outreach to members based on preventative screenings and chronic care management. Optimize care management programs to remind and follow-up with members needing services. Sometimes members need a call to action and some guidance – it’s a win-win. Members get the care they need and you get the needed information to help them maintain or improve their health.

By focusing now internally and collaborating with providers and members, you can design interventions to impact the data in time for HEDIS® 2015 and close the gaps that exist.

By Elizabeth Micholovich, Senior Project Director, Health Data Vision, Inc.

HEDIS Best Practices

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.