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With HEDIS® 2015 well behind us, now is the time to start planning for HEDIS® 2016. While the active medical record collection period is short, HEDIS® is a year-round activity and there are many opportunities to make next year results even better. It boils down to data gaps and identifying where those gaps exist. With that in mind, you can identify interventions for your health plans, providers, and members. Taking action to close these gaps can drastically improve your HEDIS® and STAR Ratings for the following year.  


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A few specific ways to improve HEDIS® 2016 scores:

  • Assess and analyze what is driving gaps and close them: Such as out of network visits, providers not cooperating, and/or EMR integration not being utilized.
  • Ratchet up provider engagement: Targeted reports that give providers up-to-date patient information can assist them in their outreach efforts to encourage members to receive timely care.
  • Supplemental Data: Seek out other supplemental data sources that can help improve rates such as state registries for immunizations, health assessment data, and prior year hybrid exclusions (colorectal screening, breast cancer screening, etc.).
  • Look for opportunities to reduce provider abrasion: Consider ways to help providers anticipate and schedule HEDIS® requests and explore technologies that reduce office disruption such as remotely accessing EMRs.
  • Revaluate member engagement strategies: Consumers are demonstrating a willingness to adopt new care delivery models that are more convenient and lower cost. Payers need to experiment with technology enabled outreach programs that accommodate member’s increasingly mobile lifestyle.

The healthcare system is inherently challenging to navigate. By exercising strategies that encourage members to manage their health and facilitate greater provider collaboration, you lay the foundation for improving HEDIS® scores for 2016 and beyond.

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.