Do your HEDIS record retrieval team members have time to spare during the audit season? …. In most cases, they don’t! They need to juggle multiple priorities – supporting the roadmap documentation, making sure measure outputs are an accurate reflection of real-world performance, chasing providers, handling queries, supporting abstraction and preparing for audits. As if that was not enough, they always get pushback from dissatisfied provider partners leading to additional logistical challenges. However, like any business process, you need to manage a few key things appropriately to run a highly efficient HEDIS chase campaign.
Preparing for HEDIS Season
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- Identifying right measures to chase – Evaluate your health plan’s performance over the past couple of years and identify measures that have tangible business impact. They may be measures that can help cross over to a bonus-eligible Star threshold, or measures where chart retrieval rates have been high historically. Identifying the right measures is critical and should be completed ideally even before the plan year ends. The analysis should begin once the Q4 gap closure activities starts winding down.
- Pre-scheduling – Some key provider groups, especially the ones serving a large portion of your plan’s population, are always likely to show up in your list of providers to chase. It is thus helpful to schedule time with these providers early in the HEDIS season to get a head start on chart collection.
Chase Execution
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- Pre-chase Screening – For the few measures where the lookback period is more than a year, it is helpful to assess existing supplemental data of sampled members. Often the existing charts which may not have been fully abstracted yet can provide the required information, eliminating the need for a fresh chase.
- Chasing the right provider, not every provider – Attributing open gaps to providers is only the tip of the iceberg. There needs to be a concentrated effort towards ensuring that the first-hit-rate is high and precious resources are not wasted in multiple chases across different providers, trying to close gaps for the same measures. This is best driven by mapping measures to provider specialties and visit types, followed by analyzing patterns of interest. These patterns can help determine success rate in gap closure across providers, measures and member demographics. Automatic scoring can then easily highlight the probability of a provider having the chart that can close a gap.
- Integrated chase, not just HEDIS – While HEDIS chases are effort intensive, there are enterprise-wide initiatives that also trigger medical record requests. These may be for Risk Adjustment (suspect HCCs, RADV), claims or authorizations and so on. Having a single integrated platform to look up existing records and combine outreach helps reduce multiple touchpoints to providers. This helps optimize the per-chase cost across the health plan reducing provider frustration.