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To be early is to be early

The Healthcare Effectiveness Data Information Set (HEDIS®) 2020 measurement year (MY) is drawing to a close. So you can breathe a sigh of relief, but do it quickly! The National Committee for Quality Assurance (NCQA) has delivered HEDIS specifications earlier for MY2021 than it has in the past. The MY2021 season began right on the heels of MY2020, as certification began in May. As for MY2022, NCQA is projected to deliver HEDIS specifications even earlier so HEDIS efforts can be performed for prospective quality programs as well.

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Reflecting on MY2020

Delivering HEDIS specifications so early requires more actionable insight for health plans to close quality gaps within the measurement periods. At Optum, we're reflecting on MY2020 to look for areas of opportunity and see what contributed to a successful HEDIS season. A few factors come to mind that you may want to apply to your organization.

  • Personalized support from vendors that build strong relationships with clients because they:
    • Serve as the point of contact for all support
    • Work directly with our engineering teams
    • Have deep subject matter expertise
    • Drive the testing process, support auditor questions
    • Focus on finding potential issues before they become problems

  • Cloud platform scalability  It is essential to have a cloud processing infrastructure that is scalable and integrates easily into your other risk programs. Even more essential is that cloud processing delivers fast, secure results to easily handle large member populations and configurations.
  • Quick turnaround of custom measures — Being able to create custom measures quickly is key to accommodating changes in growing markets and populations. Optum continually expands its measure catalog of over 200 quality measures, including a focus on Medicaid expansion, for example.

  • Retrieval and abstraction capabilities — Supporting HEDIS efforts requires proficient retrieval and abstraction with the flexibility to provide output to many different sources. For retrieval, being able to customize specific, unique chase rules by population narrows the chase volume to help improve accuracy and lower cost. Another strength to leverage is having experienced clinical staff, such as nurses, perform the overread process. This helps reduce missing important data that contributes to retrieval and abstraction success.
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Three things to do now for MY2021 and beyond

  1. Maintain a continued focus on population health reporting with member and measure-level compliance and insights. This lays a key foundation to drive prospective programs with intervention strategies. It can help close gaps, enable improved Star Ratings and member health outcomes. Maintaining this focus helps to position your organization to demonstrate your care management abilities and help win strategic business. 

  2. Digital connections are essential to quality program success. Leveraging data retrieved from electronic health records (EHR) such as Continuity of Care Documents (CCD) is critical when extracting quality data for supplemental gap closure. Direct EHR retrieval can entirely remove the need for provider action from the workflow, thus reducing provider abrasion. This works in tandem with the ability to customize traditional supplemental projects, which remains critical as digital options are still maturing.

  3. Commit to maximizing data and processes to increase the overall performance, accuracy and completeness of your HEDIS and other quality program scores. Having a solid technology foundation to support your efforts is an important practice to cultivate:

    • Efficient data aggregation — Enable a more targeted approach to closing gaps by configuring member populations to meet your specific and ever-changing needs. Faster data processing at the scale you need also enables efficiency and allows more time to focus on taking action versus waiting for results. 
    • Near real-time analytics  Since full certification will come earlier, health plans need to be ready for actionable intervention. Customized chase logic can help improve outreach and retrieval updates immediately after processing. This enables more time for gap closure. Initial data sets can be received faster, providing more flexibility to run actual data in the measurement year. 
    • Intuitive reporting Assess performance using national and internal actionable key performance indicators (KPI). Create interactive dashboards highlighting insights at the measure, provider, member and claims level. Prebuilt reports provide quick access to performance with the ability to extract data to an internal database for customized reporting needs. 
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About the author:

Curtis Adams, Vice President, Risk Adjustment and Quality Solutions

Curt joined Optum in 2019 and is responsible for empowering health plans to meet their risk and quality program needs. He is a highly experienced health care executive with expertise in helping health plans identify and quantify opportunities, then implementing strategies to realize opportunities. He has a passion for collaborating with clients to help them solve complex business problems.

Prior to joining Optum, Curt was the CFO for Conduent Inc’s largest government health care solutions client. His broad industry experience also includes key strategic roles in investment banking and technology firms.

Curt earned a BA in marketing from the University of Utah and an MBA from Carnegie Mellon University. He enjoys living among the mountains of Bozeman, MT, with his wife, and dog, Larry.