Healthcare Effectiveness Data and Information Set (HEDIS), the proprietary set of metrics used by federal agencies and health plans to gauge care quality, has long shaped how behavioral health providers understand and improve member outcomes. Health plans track these clinical outcomes very closely. Increasingly, providers have certain HEDIS measures they must meet or exceed within performance-based agreements with payers. Additionally, as value-based care models continue to expand, the ability to understand and respond to HEDIS performance is becoming an essential component of provider success.
While HEDIS is a major way that quality of care is measured, providers often do not receive the full scope of data they need to understand performance opportunities, nor the support they need to effectively address those opportunities. As an example, providers don’t have access to claims data, and the level of detail shared by health plan partners varies from organization to organization. Even when providers gain access to specific metrics, they don’t always receive a lot of context to enable actionable, tangible next steps based on the data.
“The heart and soul of these metrics represent the outcomes we all want,” said Sarah Mansouri, Market President for Wayspring in Kentucky. “But to effectively leverage them to drive better patient outcomes, providers need transparent data, paired with clear strategies for improvement.”
Based on Wayspring’s various collaborations and provider partnerships across the state of Kentucky, Mansouri has compiled the following 5 key strategies for improving your HEDIS performance.
1. Be intentional about closing gap
There are many priorities competing for your attention as a provider. Important metrics such as readmission rates and early discharge rates are top of mind, as are a host of operational and financial measures. As mentioned above, HEDIS performance is going to only become more critical moving forward, so maintaining a specific focus on these measures and being intentional about how you are closing HEDIS-related gaps is a meaningful first step.
2. Square up coding and billing practices
A simple place to start is making sure you stay up to date on all health plan and NCQA guidelines, which change annually. Make sure you have a process in place to consistently code and track all activities that relate specifically to HEDIS measures, understanding that some codes are not directly billable but still count toward closing HEDIS gaps. For many practices, getting a better handle on coding and billing can go a long way.
3. Find the data you’ve been missing
Understanding the importance of HEDIS measures to fuel improvement, you must find ways to access data that has not been historically available. Wayspring will soon be making this challenge easier to overcome. We will be enabling access to performance data related to HEDIS measures, both at the individual provider level, as well as statewide benchmarks. Data will be available 24/7 via a secure online portal. For providers who use Wayspring’s platform to access outcomes data, the addition of HEDIS specific insights will greatly improve your ability to make proactive, concrete decisions based on your actual performance.
4. Expand your locus of control
When it comes to HEDIS, it can feel like a lot of variables are outside your control and that you are limited in your ability to impact these measures. Find ways to extend your reach through care coordination efforts. You can consider hiring a care coordinator to help patients reduce barriers and quarterback each patient’s care, and/or relying on proven third-party resources, like Wayspring, to tackle obstacles and maintain support when individuals are outside traditional care settings.
5. Work harder for hard-to-reach populations
The more difficult a population is to reach, the more effort it requires from you. Be relentless and creative in how you engage patients, particularly when they are not within the confines of a treatment facility. Mixing modalities and approaches is important, as is finding unique ways to combine delivery of clinical and social support.
HEDIS is a priority for ALL providers
Not all providers currently have HEDIS measures as part of their health plan contracts. Even if you are not being held accountable yet, this should still be a priority. Here’s why.
As the healthcare industry continues a shift to value-based care, HEDIS will become more and more important across the board for providers. The federal government is pushing for the vast majority of Medicaid patients to be served by value-based models by the year 2030. Health plans are following suit, extending their participation in value-based models every single year. Soon, all providers will need to be ready for accountability related to HEDIS measures.
At a more basic level, HEDIS measures are a proxy for better patient outcomes. If you’re thriving when measuring HEDIS, it means patients are receiving more follow-up care, adhering to medications and getting social needs met. All good things.
“We are quickly approaching a world where SUD treatment is fully aligned to prioritize and reward quality, long-term outcomes for patients, creating a huge opportunity for all of us to think and act differently,” Mansouri said. “This evolution also creates an environment where all stakeholders can make patient care better, together, in ways that weren’t possible before.”
Want to learn more about how Wayspring is approaching HEDIS, and how we can help your patients achieve long-term success? Contact our team today.