Best Practices During HEDIS® Digital Transition
The healthcare industry is undergoing a rapid shift toward digital quality measurement, with the CMS outlining a plan to transition all measures to Electronic Clinical Data Systems (ECDS) and digital measures by 2030. As this transformation accelerates, quality performance teams should ramp up best practices to navigate the transition successfully. Leveraging robust performance monitoring and outreach tools, such as Jiva’s Care Quality Navigator , can provide critical insights to optimize HEDIS® and Stars performance. ZeOmega has compiled a list of best practices and important information to help your team stay ahead of the digital curve.
Source: https://www.ncqa.org/hedis/the-future-of-hedis/
Retrospective vs. Prospective: Understanding the Shift
Historically, quality performance has relied on retrospective reviews for hybrid measures, with teams conducting chart reviews at the end of the measurement year. This approach, however, is quickly evolving as digital measures require real-time, prospective monitoring.
Hybrid Measures:
- Retrospective reviews and submissions remain in place for many hybrid measures for now.
- Teams must adhere to strict regulations for supplemental data entry, timelines, and audits.
Digital Measures:
- Prospective reviews remain ongoing throughout the measure year.
- Early identification of care gaps is essential. Solutions like Jiva’s Care Quality Navigator should be implemented as early as the first quarter to allow time for outreach and intervention campaigns.
- Ensuring real-time data accessibility and analysis can improve measure performance well before final submissions.
Planning: Laying the Foundation for Digital Success
A proactive approach to planning is essential to maximize performance in the digital HEDIS journey. This requires evaluating tools, assessing interoperability, and leveraging predictive analytics.
Tool and Vendor Review:
- Assess the accuracy and efficiency of your current HEDIS solution. Are your tools delivering on their value proposition?
- Identify data retrieval challenges and ensure that vendor integrations align with your strategy.
- Engage both business and technical stakeholders in vendor selection and tool optimization discussions.
Interoperability and Integration:
- New data sources, such as HIEs and EHRs, can enhance performance but require careful integration.
- Account for data lags and standardize interoperability approaches, such as FHIR and CQL, to accelerate implementation.
- Conduct thorough validation of data mappings to prevent quality reporting errors.
HEDIS What-If Scenarios:
- Review measure criteria, scoring methodologies, and past performance data to identify potential improvement areas.
- Model different scenarios, such as changes in specifications, narrow-margin measures, and new data sources, to project scoring impacts.
- Stay informed about which measures are transitioning to digital and assess how operational changes will affect overall performance. Is this a measure in which you’ve historically relied on retrospective review to reach your target?
Create Your Own HEDIS Roadmap
As CMS and NCQA move toward full digital implementation by 2030, organizations must develop a long-term strategy to ensure readiness.
Understanding the Timeline:
- Stay updated on NCQA’s phased transition plan and ensure your roadmap aligns with evolving regulatory requirements.
- Prioritize digital transformation efforts in accordance with NCQA’s shifting landscape.
Developing a Data Wish List:
- Monitor MRR volume and pinpoint gaps to build a robust data enhancement plan.
- Expand HIE connections, optimize data architecture, and brainstorm enablement plans for clinics to participate in digital quality reporting.
- Set annual chart review targets to balance workload and ensure timely submissions.
Optimizing Your HEDIS Engine for ECDS:
- Ensure that your analytics infrastructure is equipped for ECDS reporting.
- Validate that your system supports FHIR® and CQL for standardized data exchange.
- Organize and refine mapping for data repositories to enhance HEDIS performance and improve data extraction efficiency.
Conclusion
The transition to digital measures represents both a challenge and an opportunity for health plans. By shifting toward prospective monitoring, refining planning strategies, and developing a future-focused roadmap, organizations can position themselves for long-term success. With proactive planning and the right technology investments, your team can arm themselves for success with the transition to digital measures, ensuring sustained quality performance and better quality bonus payments in the years to come.
To talk about how ZeOmega can help, please reach out.
