Launched in 2015, the HEDIS® digital medical information methods (ECDS) reporting commonplace gives payers with a technique to gather after which report structured digital medical information for HEDIS high quality measures. The aim is to take away grey areas from written specs, streamline information acquisition, and foster interoperability for extra real-time, actionable information. Decreasing the burden of guide chart evaluate also can give plans extra time to give attention to prioritizing member outreach, decreasing remedy prices, and shutting gaps in care. This is a vital step in bettering member outcomes.
Screening charges are a vital side of many HEDIS measures, and growing these charges improves each member well being and plan high quality scores, in addition to decreasing healthcare prices. Common most cancers screenings, for instance, can catch a few of the most deadly cancers, akin to colorectal most cancers. In reality, common colorectal most cancers screening can scale back mortality by catching precancerous polyps or detecting most cancers at its earliest stage, when remedy can result in a 91% survival price after 5 years. Nonetheless, 31.2% of adults 50–75 years previous report not being updated with really helpful screenings, in accordance with probably the most lately obtainable information—and as of 2021, the U.S. Preventive Companies Process Pressure recommends screening for these 45–49 years previous as properly.
Presently, the colorectal most cancers screening measure (COL) could be reported utilizing both administrative information (the “administrative technique”) or administrative information supplemented with medical report evaluate for a pattern of members (the “hybrid technique”). Nonetheless, beneath necessities from the Nationwide Committee for High quality Assurance (NCQA), plans must transition to the digital medical information methods (ECDS) technique as of Measurement Yr (MY) 2024, in the event that they haven’t already.
With COL set to grow to be an ECDS-only measure shortly and different measures to comply with, under are 4 methods a plan ought to think about to optimize their HEDIS scores and effectivity:
- Don’t overlook to avoid wasting: Save your chart evaluate outcomes 12 months over 12 months as “pseudo claims” in your HEDIS reporting software in an effort to use the information once more. This may be thought-about a supplemental feed and would subsequently require auditor evaluate.
- Be proactive: Carry out low season chart evaluate in your members and use this information as a non-standard supplemental supply. This information would additionally have to undergo auditor validation, however gives a technique to bridge the hole within the first 12 months of ECDS measurement.
- Collaborate: Work together with your suppliers to get the historic information on their members. Make certain your suppliers perceive why this shift is occurring and collaborate with them to pick the correct metrics, benchmarks, and reporting to correctly interact in closing any gaps.
- IT is essential: Deliver all stakeholders collectively as early as attainable. Speak to your IT workforce about making a repository to accommodate historic screenings that aren’t coming from claims to make sure future entry to this priceless information.
As NCQA famous in a Might 2021 report on the way forward for ECDS, plans nonetheless wrestle with standardizing information seize on the level of care and effectively sharing data between healthcare methods, which makes the transition to ECDS-only reporting tougher. Nonetheless, as soon as these challenges are overcome, plans will reap the advantages of improved interoperability and extra sources to commit to bettering member care.
Study extra about this and different profitable methods for proactive hole closure and digital medical measurement throughout Cotiviti’s webinar wrapping up the MY 2021 HEDIS season on Wednesday, July 20.
HEDIS® is a registered trademark of the Nationwide Committee for High quality Assurance (NCQA).