Quality and HEDIS

Quality care, and HEDIS measurement go hand in hand. HEDIS which stands for (Healthcare Effectiveness Data and Information Set) is a way for providers, plans and IPAs to measure the effectiveness of quality care. Many of the measures are designed to proactively provide care that is most effective for each age group or gender. While other measures let us monitor different disease states in a way that allows for better results in treatment.

Health care delivery providers be it your local doctors or plans who have higher scores are proving though this data that outreach to provide care is important, whether it is by mail, phone or other means. It also demonstrates innovation in the way care is provided by forecasting preventative services in an expedited manner.

Why It Matters?

You Deserve for the plan you choose and your doctor to do everything in their power to keep you healthy! HEDIS allows us to review and make sure this is happening by condensing all the measures into 3 key areas:

  1. Effectiveness of Care – Providing preventative health and following a care plan to prevent as best we can those who are sick from worsening.

  2. Risk Adjusted Utilization – Making sure those who need critical services can receive them and that anyone who can help is involved in your care if you have an acute condition.

  3. Access to Care – Ensures that everyone who needs an appointment can get one within a reasonable timeframe and that no one is being left out.

How we Help

Nivano Physicians works closely with your doctor to make sure any care gaps are addressed and most importantly that our doctors in network have all the tools they need to deliver quality care.

Resources Available to You

As a member of Nivano Physicians you also have the benefit of receiving access to quality care tools.

  • Member Portal – A online platform with quality care reminders and access to authorizations. Ask your provider to receive access to your Member Portal account.

  • Automated Calls and Message Reminders – From time to time you may get calls or text messages from us or your doctor to schedule appointments or get recommendations for preventative health visits.

  • Outreach by our Care Team – If you are due for a visit our courteous team of medical professionals will reach out to schedule an appointment.

  • Mailers – We periodically securely mail appointment information or recommendations based on HEDIS quality care metrics.

  • Printed Material - Each our provider offices has informative posters as well as printed material on each measure that you may be due for this year. Visit your doctor’s office for more information.

  • Open Authorizations – You do not need to wait to get specialty referrals based on quality care programs. Call your doctor and ask for an open authorization to get access right away or call us at 916-407-2000.

  • Transportation – Need help getting to your appointments? Your plan has you covered. Check out our transportation page for more information.

  • Care Rewards – Sign up for one of our Clinic Days in your neighborhood to get quick access to quality care and a Gift Card for coming to see us! Check our social media page for the latest updates or call us at 916-407-2000.

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