The annual HEDIS® data gathering, reporting, and submission process is typically a retrospective activity: health plans retrieve and abstract medical charts to demonstrate the quality of care they provided during the previous year, which is known as the measurement year (MY). By the time January 1 arrives, plans no longer can close care gaps, influence member actions, or perform provider outreach that would impact the current reporting year’s measure scores—which puts plans that don’t have a year-round strategy at a disadvantage when it comes to ensuring care plan adherence and gaining quality bonuses.
To stay competitive today and drive the preventative care impact desired, plans must shift from focusing on retrospective HEDIS collection toward building a select, structured, and intelligent foundation for in-year HEDIS. This lays the groundwork for displaying their success in improving access and obtaining preventative and curative member care. This in-year strategy can be accomplished through robust data collection, pristine and targeted member engagement, and refined care management efforts. Here are five best-practice tactics that health plans must adopt to improve their program and ultimately their annual HEDIS measure scores.
