The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used for health care performance measurement. Called the “Gold Standard” by the NCQA, HEDIS is used by 90% of Health Plans in the country. HEDIS is important because it standardizes how plans collect, audit and report critical clinical data.  Creating an equal playing field for all health plans, HEDIS data can be used by organizations and patients to help rank health plans.HEDIS measures are critical to the overall healthcare ecosystem as it ensures payers are collecting and analyzing data as it relates to their performance.Many payers start using value based reimbursement models to help meet HEDIS benchmarks., which in turn helps close gaps in care. According to a recent article in HealthPayerIntelligence, improving HEDIS scores has become a big trend among payers.

What are payers doing to improve HEDIS scores?

  • Humana has partnered with Mount Sinai Health Partners to focus on value based care which they believe with help also focus on HEDIS measures.
  • Blue Cross Blue Shield of Rhode Island has invested in value based payment methods and innovative analytics software to help improve data collection and HEDIS scores.

How to Improve HEDIS Scores?

In an interview with May Barton, HealthPayerIntelligence outlines a few ways payers can work at improving their HEDIS scores.

  • Analyze data to identify quality care gaps
  • Recognize places for improvement (example given is testing) and send reminders to patients
  • Change the way they pay for claims
  • Change what services are accessible to providers
  • Invest in telemedicine or mobile care for patients

“There are definitely some great examples of insurance companies that have set up value-based contracts with provider networks. This helps align the incentives for provider networks to do preventive screenings and to take good care of their patients with cardiovascular disease. Using measures exactly like HEDIS measures that we ask health plans to report on or, in some cases, slightly altered measures. One of the hallmarks of the HEDIS measures that health plans are subject to is that they are focused on the denominator of patients who are enrolled in the health plan.” Mary Barton, Vice President for Performance Measurement for the NCQA

BHM understands the role that data and reporting play in road to quality care and performance. Click here to learn more about how BHM can help you.