What is HEDIS Anyway? Preparing for HEDIS Season

With HEDIS season right around the corner, don’t fret if you aren’t quite ready – Judge is here to help.

What is HEDIS? If you’re reading this article, you may already know that the “Healthcare Effectiveness Data and Information Set‚” (HEDIS) is a tool designed to measure health plan performance and plan members’ overall health and wellness.

Although it’s used year-round, we’re quickly nearing peak season (beginning in December) meaning your organization will likely see a rush of audits, data verification, medical records, and claims.

As always, the best way to avoid more headaches than necessary is by being proactive and taking action! So, if you’re ready to get your team, providers, vendors, and data organized, let’s dive in.

Revise Your Process

Think back to the last year. What did your team struggle with? What set you behind? If your goal is to improve your HEDIS score, identify any obvious obstacles you faced. Carefully study HEDIS quality measures, and gather your team to discuss potential improvements. Finally, collaborate with your most trusted HEDIS vendors in order to develop better solutions. If you pay attention to the most important variables and revise your process in advance, your score will surely improve.

Prepare Your Data

Ensuring accurate data is the key to a successful HEDIS season. To build a solid foundation, begin with a thorough review of contact information, practice location, medical records, and any other pertinent information. By prepping this data early, you’ll maximize your “retrieval rates” and save your team valuable time when things get busy.

Re-Evaluate Communication Methods

Rather than run headfirst into peak season, come up with a plan for communicating to your vendors, providers, and members. Here again, start with what slowed you down in previous years. Delineate expectations to team members by setting clear instructions and deadlines, establishing points of contact, and determining what information you’ll need from patient charts. Focus on identifying all the intermediary steps that may stall (or increase) the efficiency of your communication flow.

Assemble Your Team

Your tools are only as useful as the team that wields them. Start thinking about your staffing needs. Can your internal team handle all the work, or should you hire external consultants? For reference, look at your previous year’s HEDIS performance and review your budget for the coming year. Many teams decide to hire temporary staff amidst peak season, so make a decision in advance unless you want to be stuck searching for help when you’re too busy to leave your desk!

Once you’re close to forming your team, focus on scheduling training sessions and setting expectations for the upcoming rush. During training, offer refreshers about HEDIS MMR, vernacular, and software. Address last year’s concerns, whether it’s data entry errors, communication issues, or technological hiccups. If you allocate enough time to familiarize your team, the whole process will run much smoother.

We can’t say it enough – procrastinating will only lead to costly, last-minute scrambling. Preparing for HEDIS season in a timely manner will keep you from falling behind when it counts most. Review HEDIS quality measures to keep your score high, and your team’s stress low. Good luck!