Learn How to Improve Your Scores of HEDIS Measures

National committee on Quality Assurance developed the tool of HEDI (healthcare Effective Data Information) for evaluating the services and quality of health care which are rendered under the health plans by the healthcare industry. More than 90% of America’s health care programmes are measured on different dimensions of service and care  with the help of HEDIS.

In 2015, HEDIS added 83 measures in five different domains of care. There is a team of experts which is formed to review the structure of health plans and operations which are against the standards of NCQA’s like care availability, patient safety, experience and effectiveness of the care and other important service areas.The HEDIS measures allow employers and consumers to determine the coverage option which is  best and optimal health care service.  These measures are most common standards for judging performances among different care facilities like medical homes and ACO (accountable care organization). These measuring standards are derived by medical billing claims among insurance companies together with Medicare and Medicaid programs.  

Each Managed Care organization (MCO) have to pass through an NCQA Compliance Audit in order to ensure that the MRR is reliable and accurate before reporting publically their HEDIS. you will have to meet the deadline of the data collection which is late May for health care plans.

Learn few tips to improve your scores of HEDIS measures:


Superior Documentation

Documentation plays an important part for improving performance and in quality measures of HEDIS. The healthcare industry has made a transition to ICD-10, claims which  are sent in with incorrect codes or wit ICD-9 forms will not going to enhance your quality standards.

Make sure that the patient or consumers healthcare services are documented properly in electronic medical records. Any kind of error or mistake done in medical record could become an obstacle in meeting quality measures of HEDIS.

Providers and payers need to ensure that deadlines for certain services are met for maintaining the high standard of HEDIS. Preventive care is one such service as it is important to ensure that immunizations are completed before the second birthday of the child.

Proper documentation is the key to add high quality of medical care. Physicians can plan treatment of patient and can monitor all the vitals which are based on completion procedures and medications.

When filling the claims for ensuring payment for the service which you have rendered, try to get a clear picture of procedure and services through medical records. This data will prove to be useful for educating medical industry for clinical research.

Patient Engagement and Population health Management

The San Francisco health Plan came up with a report which is called Our “Journey to Improve Quality and the health of Our Population” payers can get benefit through providing support to provider network through the mode of health management strategies.  Additionally health payer can enable additional consumer engagement and direct outreach.

For success in your HEDIS scores incentive programmes where members win gift cards on completing recommended services. Additional interventions are automated and live reminders through phone calls for due care and providing materials on health education and supporting providers for teaching the patients to get recommended care and manage their health.

With a greater analysis of clinical data and building a direct reach to the members needing care, payers can improve their score card in an effective manner. HEDIS standards of quality are based on experience of the patient. Providers and payer have to engage with their patients so they can attain better scores by improving the communication between primary health care teams and your patients.

For remaining in constant contact with patient portals are great help. You will not have to appoint schedules for the purpose of patient engagement. Some of These patient portals helps you to keep in touch with your patients through messaging. It will further going to help the physicians to remain focused on the pertinent cases rather than wasting time in the unnecessary appointments. For the purpose of prescription refills and management of chronic disease these patient portals are most useful.

Preventive Screening and Patient Care

Two most effective ways to improve HEDIS scores are:

  • Identifying the patients who requires well care assessment. This can be determined by looking and analysis the aps in your care list.
  • Addressing appointment and scheduling issues.

Providers need to include plenty of patient care measures such as:

  • Conducting pap tests and mammograms
  • Measuring levels of body mass
  • Managing cholesterol and hypertension
  • Completing immunizations

Payers always prefer the providers which renders high quality services and have always meeting the quality measures of HEDIS.

It is clear from the above discussed points that you need to improve the entire phases of HEDIS process such as Medical record review, real time reporting, detailed records of the audits, medical record abstractions and submission of NCQA. A team of accredited coders will be a great help in data optimization. Ensure an accurate documentation of HEDIS claim submission with the specific code measures of HEDIS.