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The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used by 90% of the United States’ Health Plans to measure performance on important elements of care and service. HEDIS standardizes the way health plans collect, analyze, and report data. It creates an equal playing field for all health plans (who use HEDIS) to be compared. It also can be used by employers, consultants, and patients to find the best health plan match for their needs. Many payers are now using value based reimbursement models to help meet HEDIS benchmarks. These value based programs make providers accountable for closing gaps in care and meeting HEDIS measures.

In a recent article in HealthPayer Intelligence “Why HEDIS Quality Measures Matter for Value-Based Care,” Vera Gruessner discusses the relationship between HEDIS and value-based care.

According to Gruessner:

HEDIS measures are being adopted and followed by many public health payers who are moving towards value-based care. One example is WellCare of New York who according to a company “signed value-based care contracts with Corinthian Medical IPA, Bronx United IPA, Coalition of Asian-American IPA, Eastern Chinese American Physicians IPA, the Community Healthcare Network, and the Children’s Medical Group¹.”

Tips for Meeting HEDIS Measures

  • Proper documentation and efficient reporting is key, both for payers and providers.
  • Payers can encourage providers to support quality patient outcomes through incentive programs (value based reimbursement)
  • Focus on both on population health management and patient engagement
  • Analyze data

HEDIS and Value Based Reimbursement

Gruessner focuses on one particular case: Blue Cross Blue Shield of Rhode Island. BCBS of Rhode Island has been working to ensure it achieves HEDIS benchmarks. BCBS Rhode Island reported that they were able to close 34,000 gaps in care after they implemented new quality measures.

“First, I wanted to create a very substantial pay-for-performance program where our providers are our partners in closing gaps in care. It’s all about closing gaps in care for HEDIS. So we put in place a very robust pay-for-performance program in the millions of dollars that we rolled out to our providers.” Nancy Mamo, AVP/Managing Director of Population Health Analytics at Blue Cross Blue Shield of Rhode Island,

What BCBS Rhode Island Did to Meet HEDIS Standards

  • Collected and analyzed population health data and patient data
  • Implemented robust pay-for-performance program with many measures in place to help close gaps in care
  • Created “reminder cards” for patients who may need help remembering annual appointments or screenings

¹Read the full article and interview here.

2017-05-17T12:58:53-04:00By |Health Insurance, Uncategorized|

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