Bridging the Gap with HEDIS® Measures

The Healthcare Effectiveness Data and Information Set (HEDIS®) is a tool used by U.S. health plans to measure performance of care and service. Simply put, HEDIS® involves a review of health care services to ensure care is meeting quality standards. Both payers and providers are looking to provide better quality, greater value, and improved patient satisfaction. Therefore, it’s important for every health plan to evaluate quality and performance regularly to ensure the plan’s continued success. 

The Impacts of HEDIS® Measures 

HEDIS® measures span all types of clinical care and strive to ensure that providers are following evidence-based guidelines. Impacts of HEDIS® measures are felt far and wide and cover everything from the appropriate use of anxiety medications to ensuring patients receive the preventive screenings and immunizations they need. 

These measures were introduced by the National Committee for Quality Assurance (NCQA) and scores are used by the Centers for Medicare & Medicaid Services (CMS) to monitor performance for managed care organizations (MCOs). Performance on these measures impacts Medicare’s star ratings and NCQA health plan ratings. Improving HEDIS® scores is a priority for health plans as they analyze great amounts of data to identify opportunities for ongoing improvement.

While HEDIS® is an effective tool for measuring quality, tracking performance against these measures can be challenging for payers. The retrieval of data can be a complicated process when working with providers to collect data from electronic medical records (EMR) and paper charts. Other challenges include getting providers to respond and release records upon request which may come in the form of fax, mail, EMR or secure FTP sites.  

Provide Better Data, Better Measures and Better Care with Primavera 

Fortunately, Primavera’s Health’s new initiative of bridging the gap with the HEDIS® measures will provide better data, better measures and better care. We believe health organizations should be able to analyze HEDIS performance levels and trends to determine where to focus efforts and overcome HEDIS challenges. 

Here are a few ways Primavera’s technology can help healthcare organizations address HEDIS® headaches and improve scores. We design Comprehensive strategies to identify and close gaps in care for you to obtain the best quality scores — and get your members the care they need.

  1. HEDIS® Analytics & Reporting: Tracking, monitoring and improving scores at the patient, provider, location, insurance pcp and payor level – Allowing your team to measure direct impact
  2. HEDIS® & STAR Analytics: Develop and customize your healthcare organizations HEDIS measures to fit organization needs and expectations
  3. Identify Care Gaps: Data-driven insights to identify patient care gaps that directly impact HEDIS® measures

Primavera customizes value-based care solutions based on your needs, to drive better clinical and financial outcomes. Providing revenue optimization and improved medical economics. Our experience and expertise in value-based care strategy and implementation allows you to focus on ensuring patients get the right care – with quality health outcomes.

Discover how Primavera’s leading HEDIS® measures tracking system can transform your data into actionable insights, allowing you to monitor, improve and automate HEDIS® scores in our Data Analytics platform year-round.

Reach out to us today to learn how we support you to continually improve HEDIS® outcomes across your organization.

(888) 667-2219

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

Rolian RuizBridging the Gap with HEDIS® Measures
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