Through our partnerships with health plans, we speak often about what makes a health plan successful and what challenges are faced along the way. Health plan clients have begun to implement plans to meet their 2021 strategic objectives, and a number of them have recently escalated management of HEDIS Measures, so it’s worth spending some time on that subject.
HEDIS, or Healthcare Effectiveness Data and Information Set, is a set of standards used to measure the quality of health plans. HEDIS includes over 90 measures across 6 domains of care, including several time sensitive measures that can be challenging to manage well without access to adequate real time information.
Beyond the obvious benefit of improved member outcomes, it’s easy to see why plans have a heightened focus on their performance. NCQA Health Plan Ratings and Medicare Stars Ratings both consider HEDIS measure performance in their calculations. It helps Health Plans identify areas of improvement and care gaps. It plays a role in value-based care arrangements and evaluating provider performance. HEDIS performance can also help guide consumers when purchasing health insurance.
Given Collective’s prominence in the care collaboration space, we often participate in conversations around how we can improve performance for time sensitive HEDIS measures. Most recently there has been a focus on “Follow-Up After Emergency Department Visit for People with Multiple High-Risk Chronic Conditions” (FMC). This measure requires that members with two or more of a specified list of chronic conditions receive a follow up service (visit, tele-visit, etc.) within 7 days of an Emergency Department (ED) visit. The Centers for Medicare & Medicaid Services have signaled that this measure will be incorporated in Medicare Stars ratings in the future.
To obtain the best outcomes, health plans should prepare in the following ways:
- Flag members with comorbidities that would require a follow up should they seek ED services. This becomes a particular challenge in January as most plans have an influx of new enrollees previously unknown to the plan.
- Establish connections that provide real-time notifications when this subset of members accesses the ED. With just a 7 day opportunity to close this gap, it is imperative that plans learn of the ED visit in real-time and take action quickly
- Enable Value Based Care partners with real-time information about members requiring time sensitive follow up after ED visit.
Healthcare outcomes are best when a fragmented system is aligned on common objectives and collaborating on a common platform. Quality measures, including FMC, are no different. Collective works with health plan clients to enable real-time collaboration within each users’ workflow.