Streamlining HEDIS reporting for payers and providers

As both State and Federal governments move toward a healthcare industry driven by quality and value, HEDIS rates are becoming more and more critical, not only to the health plan. To effectively engage patients in care using decision support tools and HEDIS score as a proxy, timeliness, validity, and data submission adequacy are crucial. Payers and providers need to collaborate in determining an ongoing data exchange process that extends beyond performance reporting and centered around patient engagement use cases and reconcile varying data sources to help organizations close gaps in care and health equity.  

What process should organizations use to exchange data? What functionality should be built in EHRs to facilitate or automate this process
and reduce the administrative burden? How can data be used to seamlessly engage patients in care while considering meaningful stratifications such as age, gender, and socio-economic status?  

Automating data collection and reporting. 

Payers and providers play a crucial role in determining appropriate engagement methods to help individuals access care in a way that
aligns with their lifestyle, clinical and social configuration. As both entities seek to improve performance, identifying a collaborative method to automate and digitize data collection ensures patient engagement and care timelines.  

Data exchange process considerations include. 

• Frequency and submission methods. Organizations must align submission formats throughout the year to effectively monitor, analyze, and implement change management processes. Additionally, NCQA’s roadmap continues to advance automation of HEDIS reporting, and organizations can leverage tools and methods as they align HIT infrastructure and use of human resources.  
• Electronic Clinical Data Systems (ECDS). Allows organizations to reconcile and provide complete information using clinical systems, such as EHRs, clinical registries, HIEs, claims, pharmacy systems, immunization information systems (IIS and care management systems. Aggregating clinical data in this format helps create insights on how to manage health across populations best. Payers and providers can determine data sources used for monitoring and performance calculation. 
• Digital measure (dQMs). For many years, organizations have interpreted and even negotiated how HEDIS measure definitions translate to clinical documentation in EHRs. With the use of digital measures, HEDIS specifications can download directly into users’ data systems. 
• Interactive Data Submission Systems (IDSS). In 2021, HEDIS data will be collected in a new format, allowing for more meaningful structured data elements to facilitate stratifications to advance quality and health equity objectives. 
• Surveys. Use of off-cycle Health Outcomes Survey and CAHPS activities to monitor and evaluate improvement activities. 

Downstream use cases. 

Reporting and collecting data help organizations identify and understand clinical and social opportunities. However, using the data’s
insights directly impact our ability to empower patients to prioritize their health access care. Stratified reports can help identify targeted populations that consider conditions, utilization, preventive care gaps, and socio-economic status. A stratification process can then inform the implementation of improvement activities such as:  

• Patient outreach
• Telehealth, including remote patient monitoring  
• Educational content 
• Health reminders  
• Advanced wellness and care management programs 

To promote efficient use of resources to improve HEDIS reporting and performance, payers and providers must collaborate to adopt new workflows that emphasize clinical documentation improvement and automated reporting. By also partnering with vendors, payers, and providers, we can automate data exchange and improve data collection and quality reporting efficiency. 

What are your thoughts? Share with us in the Community Forum.  

1. What HEDIS collection and reporting strategies have your organization implemented to improve quality? 
2. What submission methods or formats has your organization identified as being the most impactful to workflows and performance? 
3. What clinical or operational challenges should health care stakeholders consider when implementing downstream activities using HEDIS data to improve quality and address health equity?