Just because the HEDIS® reporting season has ended, doesn’t mean that there is not still valuable chart review to be done. Those charts that hold value for HEDIS® scores and Stars rating could be coming into your organization right now.

Risk Adjustment chart collection occurs virtually year-round and there is a very good chance that your plan is acquiring charts right now for that purpose. Although there are clearly limits to how you can use partial year chart data for HEDIS® reporting, mining these charts in the HEDIS® off-season can yield potential outreach opportunities and possible valid exclusions for low denominator, administrative-only HEDIS® measures.

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HDVI’s STARs Improvement initiatives help plans leverage existing chart information from risk activities as well as gather additional charts as needed to impact several hybrid and administrative measures, including:

  • Controlling High Blood Pressure
  • Comprehensive Diabetes Care – BP
  • Comprehensive Diabetes Care - Eye Exam
  • Osteoporosis Management in Women who had a Fracture (OMW)
  • Drug Therapy for Rheumatoid Arthritis (ART)

Although you cannot use the blood pressure values found in the chart to satisfy the actual reporting for HEDIS® 2016, review of these charts can help identify non-compliance mid-year and potentially focus outreach. In the cases of measures like OMW and ART, these generally have low denominators and fairly wide exclusion criteria. Locating only a few valid exclusions, that your auditor approves, can help a plan move the needle on these administrative-only measures.

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.