In the ever-changing landscape of healthcare, a large number of Americans find themselves dissatisfied with their health coverage. But very few health plans have managed to attain the coveted 5-star rating from the National Committee for Quality Assurance (NCQA). As stakeholders strive to enhance the quality of care provided, the Healthcare Effectiveness Data and Information Set (HEDIS®) and its accompanying measures for healthcare organizations remains a pivotal factor in achieving high NCQA ratings.
According to NCQA, more than 227 million people are enrolled in health plans that report results from HEDIS, making it one of the industry’s most widely used performance improvement tools. Understanding how to improve HEDIS scores can help payers adopt a strategic approach to meeting the stringent standards set by NCQA and pave the way for a healthcare landscape that exceeds the expectations of the American population.
What Are HEDIS Measures & Why Do They Matter?
HEDIS measures have been established by NCQA to assess performance in healthcare across specific areas in which improvements have the potential to make a meaningful difference in people’s lives. They are designed to help identify gaps, monitor improvement success, and offer standards for easy plan comparison.
More than 90 measures cover six domains of care:
- Effectiveness of care
- Access and availability of care
- Experience of care
- Utilization and risk adjusted utilization
- Health plan descriptive information
- Measures reported using electronic clinical data systems
HEDIS measures matter because they serve as a reflection of a healthcare organization’s effectiveness in delivering patient care or a payor’s effectiveness at implementing preventive healthcare initiatives. Any deficiencies can result in a decrease in HEDIS scores and impact a commercial, Medicaid, or Medicare payer’s status as a quality health plan. Remedying these gaps and improving the patient experience are essential steps in enhancing HEDIS scores.
How Can Payers Improve HEDIS Scores & Health Outcomes?
Improving your health plan’s HEDIS scores and member health outcomes is an ongoing effort that can require a number of different strategies. One avenue is to leverage advanced technology and analytics solutions. By embracing cutting-edge tools, healthcare organizations can bolster their population health management strategies to ensure a more comprehensive and targeted approach to patient care. These solutions can not only streamline data processing but also empower providers with actionable insights, enabling them to proactively address health disparities and focus on preventive measures.
Incentivizing physicians to adopt new technologies and investing in other provider engagement programs can help align the interests of healthcare professionals with the objectives of HEDIS improvement. In addition to technology, fostering a culture of continuous improvement is both crucial and conducive to positive member outcomes. Encouraging healthcare providers to embrace innovation and regularly reassess their practices contributes to sustained HEDIS score enhancements.
Collaboration among healthcare professionals also builds a dynamic ecosystem that thrives on shared learning and best practices. Encourage providers to connect but also do some connecting yourself by integrating with technology partners to ensure a more comprehensive view of patient data and facilitating referrals to SDOH-based support to improve appointment or medication adherence as other non-medical needs are met.
Implement beneficiary incentive and education programs that empower and inform patients to be more active in their care and establish cost transparency programs that can help members make informed decisions as they navigate the healthcare system. Incorporating patient feedback mechanisms into provider engagement programs will also enhance the patient-provider relationship. By actively seeking input from members, healthcare organizations can gain valuable insights into the patient’s experience, identify areas for improvement, and tailor interventions that resonate with diverse patient needs and preferences.
Strategic investments in data collection efforts are also important for comprehensive HEDIS measure improvement. Many providers fall short in the way of IT adoption, which makes it difficult to gain deeper insights into patient populations, identify areas for improvement, and tailor interventions to have a meaningful impact on overall health outcomes. Payers may need to support providers in applying innovative clinical documentation methods and implementing new information systems to more effectively collect and analyze healthcare data.
Payers can focus on reimbursing providers based on the value and quality of care delivered rather than the volume of services provided. Value-based payment models are tied to achieving pre-established performance metrics and outcomes, which can help close HEDIS gaps.
Tactics for HEDIS Score Improvement
- Embrace cutting edge technology and analytics tools
- Incentivize providers to adopt new technologies
- Foster a culture of continuous improvement and innovation
- Encourage collaboration among healthcare professionals
- Implement beneficiary incentive programs that empower patients
- Invest in IT systems and data collection efforts
- Implement value-based payment models
- Explore patient or member education programs
- Build strategic partnerships within the community
Find Support from the Experts
Take your HEDIS score improvement efforts to the next level with insights and dedicated support from a team of experienced consultants. Learn more about our clinical management services and get in touch with Clearlink for more information on strategic approaches, best practices, and industry benchmarks. Schedule a meeting today.