HEDIS Specifications Access: Streamlining Data for Quality Improvement

Challenge: One of our health plan clients struggled with delays in accessing HEDIS specifications across multiple payers, which slowed their quality reporting cycles and risked missing key performance targets. The lack of a standardized intake and data access workflow created inefficiencies and increased administrative burden on their quality and analytics teams.

Our Approach: We implemented a structured process to facilitate seamless access to HEDIS specifications. This included developing clear protocols, establishing secure data pathways, and providing targeted training to internal teams.

Impact:

• Improved access to critical HEDIS data for reporting and analysis.

• Streamlined workflows, reducing administrative burden.

• Enhanced compliance and accuracy in quality reporting.

Integrating Technology for Operational Excellence

Challenge: A California-based health plan client sought to optimize operations and improve care delivery across their network through technology integration.

Our Approach: We partnered with the team to implement electronic health record (EHR) systems, enhance data analytics capabilities, and provide hands-on staff training. We designed workflows that ensured alignment between clinical and operational teams, enabling a smoother transition from manual processes to automated systems.

Impact:

• Successful EHR implementation across multiple facilities.

• Enhanced analytics for operational and clinical decision-making.

• Increased efficiency, enabling staff to focus more on patient care.

MIPS Depression Measure: Improving Screening and Follow-Up

Challenge: One of our health plan clients faced challenges in consistently meeting MIPS depression screening and follow-up requirements. Incomplete workflows and fragmented data across provider practices were creating gaps in reporting and impacting quality scores.

Our Approach: We conducted a detailed review of the client’s workflows and patient data capture processes. We developed a standardized screening and follow-up workflow, implemented tracking mechanisms for patients requiring follow-up, and provided training to clinical and administrative teams.

Impact:

• Improved capture of depression screening and follow-up data across provider sites.

• Increased accuracy and timeliness of MIPS reporting.

• Enhanced compliance and overall performance on depression-related quality measures.

Overall HEDIS Outcomes: Driving Performance Across Multiple Measures

Challenge: Our client, a regional health plan, needed a comprehensive approach to improve performance across multiple HEDIS measures, including preventive screenings, chronic condition management, and care coordination. Disparate processes and inconsistent reporting were limiting their ability to identify gaps and implement targeted interventions.

Our Approach: We performed a detailed analysis of existing workflows, identified areas of inefficiency, and implemented a coordinated approach to HEDIS measure management. This included process standardization, staff training, and development of a performance monitoring dashboard to track measure-specific progress in real time.

Impact:

• Streamlined HEDIS measure management across multiple domains.

• Enabled proactive identification of care gaps and targeted interventions.

• Improved overall performance on HEDIS measures, enhancing quality reporting and compliance.