HEDIS measures are practically a template to weathering value-based care and improving cash flows.
Take time to identify your key opportunities for improvement.
Coordination across departments will be key to your success
2019 HEDIS updates have brought some interesting changes around the treatment of opioids and immunizations.
Getting to Know HEDIS
FQHCs deal with a mix of quality metrics but the Healthcare Effectiveness Data and Information Set (HEDIS), in particular, provides a unique perspective.
The over 90 measures (divided across 6 domains of care and developed by the National Committee for Quality Assurance (NCQA) paint a picture of clinical performance specifically from the viewpoint of health plans. This information is used by these plans to track and rate the care their members are receiving. It can even influence how money for QI initiatives is distributed to your FQHC. Most importantly, though, is what it means for you in the age of value-based care.
To understand this, let’s take a look at the six domains of care:
Effectiveness of Care
Access/Availability of Care
Experience of Care
Utilization and Risk-Adjusted Utilization
Health Plan Descriptive Information
Measures Collected Using Electronic Clinical Data Systems
Now, let’s compare them to value-based care programs and how they support CMS’ three-part aim of
Better care for individuals
Better health for populations
The first four HEDIS domains directly support better care for individuals and populations, and the last three can be powerful factors in improving costs across the board.
This means that for FQHCs, tracking HEDIS measures can translate directly to gains on the value-based care front. HEDIS measures are an effective guide for FQHCs who want to adapt to a value-based care environment and thrive as the programs continue to evolve. Here’s how to do just that.
Identify Your Opportunities
FQHCs have many options to address HEDIS measures and identify areas of improvement.
Effectiveness of Care Measures
These measures (available for review here) cover a wide range of topics including prevention and screening, respiratory conditions, and children’s programs. Popular measures within prevention and screening that FQHCs have prioritized to address their patient population needs include:
When focusing on improving these measures, you’ll want to first identify gaps, set goals, and then monitor performance. Make sure to consider technology options like patient engagement platforms that reach beyond the functionality of EMR add-ons and meet your patients where they are.
Your hours of operation have an impact on accessibility, and this connects directly to the HEDIS second domain of care. If you find your measures slipping, it might be a good idea to assess them.
Consider having direct conversations with your patients and community about what times and days are most convenient for them, as well as any situations where they found it difficult to access care with you.
Meeting Components of Required Measures
Some measures include multiple components and neglecting a few can throw your numbers off. For example, comprehensive diabetes care involves screening for hemoglobin A1c, along with eye exams and blood pressure control. If your program is missing eye exams or one of the other components, it may be affecting your numbers. Make sure to review current NCQA measures if you suspect any issues.
Claim Submission and Service Documentation
Proper documentation is crucial in healthcare, but it can be a challenge for even the best providers. If you’ve had issues with denials or heavy appeals, it might be a clue that you have an opportunity to improve your HEDIS scores through proper service documentation.
Additionally, considering the changes and increased complexity we’ve seen from ICD-10, simple coding errors could be causing unnecessary blows to your HEDIS scores.
Coordinate to Improve Your Chances of Success
HEDIS is a complex system; if you want to see success in your numbers, your team will need to take an appropriate approach.
HEDIS data is multi-faceted and includes both billing and clinical information. This means adjusting your processes to meet the proper standards will require input from multiple teams. These include billers, coders, quality improvement, IT, and operations on the internal side. It’s also potentially beneficial to consult your care management team since they’re likely to have a unique insight into care effectiveness, accessibility, and the experiences of your patient population.
To get the most out of your coordination efforts, make sure your team is taking advantage of NCQA’s wide range of educational opportunities.
You should also consider setting aside time with managed care plan reps to understand their perspective on HEDIS processes and find out how you can make things easier for them.
Keep Current: HEDIS 2019 Update
HEDIS changes every year to retain its relevance and feasibility, and 2019 is no different. Here’s a look at HEDIS measures and changes that are new this year.
Hospitalization following discharge from a SNF
Risk of continued opioid use
Prenatal immunization status
Controlling high blood pressure (a new target of <140/90)
Follow-up after hospitalization for mental illness: addition of a principal diagnosis of intentional self-harm (denominator)
Telehealth for physical health measures (NCQA has introduced telehealth into 14 of the physical health measures.)
For more details and updates, review the Measures and Technical Resources here on the NCQA website.
As value-based care continues to evolve it will be even more important to understand the perspective of stakeholders, including both patients and health plans. Keep an eye on focused initiatives such as HEDIS, and if you need to take a fresh look at communicating with your underserved populations in ways they’re proven to respond, we can help.