This year, the Department of Health Care Services changed many measures that providers are expected to prioritize regarding HEDIS. Through collaboration and review, we were able to identify several challenges clinics might face in 2019. With this information handy, our Quality Management team reevaluated the HEDIS strategy and updated analytic systems to provide the most up to date reporting. We are committed to working closely with our clinics to provide them with the utmost support ensuring quality care delivery for members and improving our HEDIS scores overall.
Some of the major concerns for many clinics are the changes regarding BMI, immunizations, labs, blood pressure, and prescription data. While many are providing the care, it looks like they might not be coding accordingly. In order to be proactive, we have implemented an electronic medical records (EMR) data exchange program. This allows us to collect information from our providers’ EMR systems and submit the data to the health plan as supplemental data, thus increasing their HEDIS rates. This eliminates extra administrative work allowing them to focus on providing quality care to the members.
Our goal is to be a strong advocate for our providers. We want to not only deliver gaps in care reports to the providers, but also provide them with a variety of tools and resources to be successful. In our efforts to do so, we have developed a HEDIS Toolkit that encompasses all the resources we have available to providers in order to assist them on increasing their HEDIS rates.
A few resources we provide our groups include:
- Access to Nivano’s internal data warehouse Atlas, which allows providers to pull real time gaps in care reports and review their claims and encounters.
- A HEDIS Coding Cheat Sheet, which lists all codes the biller must utilize in order to collect the data administratively, reducing the amount of administrative disruption from medical record collection during HEDIS season.
- Utilization of Sierra Health Alerts. This communication platform allows providers to interact with patients about their health compliance requirements. Available services include custom automated phone calls, custom automated text messages, bi- directional texting for schedules, and a HIPAA compliant mobile application.
Additional resources include open authorizations, marketing posters for clinic waiting rooms and exam rooms, HEDIS preventive service reminder cards, point of care rewards for the members, and medical record review for missed opportunities.
The Quality Management team here at Nivano Physicians is confident that with the tools and resources we have available to our clinics, and our commitment to work closely with them to provide quality and timely care to our members, we will all be successful in HEDIS 2019!