Risk Adjustment

3 Steps to Closing HEDIS Gaps Early

They say the best predictor of future behavior is past behavior. That’s why, with Q3 rapidly approaching, now is the time to bring non-compliant members into compliance and close HEDIS gaps with a targeted direct-to-member compliance campaign.

Targeted member compliance campaigns that drive members to their provider in Q3 not only help close HEDIS gaps early in the year, but they promote better patient outcomes overall. A member compliance campaign doesn’t have to be complicated. In fact, with the right campaign partners an effective but streamlined campaign can be achieved in three simple steps:

 

Step 1: Target Your Campaigns Based on Tracking Measures

 

Health plans must prioritize resources to focus greater effort on members that have HEDIS gaps. This is the time to look at data from Q1 from reports that have been released that indicate gaps in care. For health plans that work with Episource, our analytics application known as epiAnalyst can identify both HEDIS measures (STAR Measures included) and HCC gaps simultaneously. Campaigns can be targeted to members with the greatest medical need and most impact on HEDIS ratings, such as those with multiple chronic conditions.

 

Step 2: Call-Outs Can Identify Barriers to Member Compliance and Provide Solution

 

Nurse practitioners and care coordinators make numerous outbound phone calls to high-risk members. A Call-Out Campaign can be fed into the nurse practitioner/care management engine, for an effective and efficient way to personally reach members, remind them of needed care and address their obstacles to compliance. While on the phone, the nurse practitioner can strive to:

  • Schedule an appointment for the member by doing an immediate three-way call with the practitioner’s office.
  • Arrange transportation with the physician’s office or medical clinic if the member is unable to get a ride to their medical care.
  • Educate about the frequency of each medical requirement. Managing chronic illness is complicated. Members may not realize or remember how often to have more frequent requirements such as A1C testing versus an annual mammogram or flu shot.
  • Address emotional barriers to compliance. A member may fear a mammogram because of discomfort previously or feel embarrassed about gaining weight from not following a diabetes meal plan. Solutions can be as simple as explaining that today’s digital mammography is faster and more comfortable; or scheduling an appointment with a Diabetes Educator or Dietitian.

 

Step 3: A Mailer Campaign Provides Effective Reminders

 

Mailed pamphlets, flyers or postcards give information that can be referred to repeatedly, to:

  • Remind members of needed testing, vaccinations, exams and procedures.
  • Explain additional care beyond routine office visits and lab tests that are also gap measures, such as eye exams for members with diabetes.
  • Provide contact information for practitioners and health plan.

Episource offers epiAnalyst to identify HEDIS care gaps, and a workflow to monitor progress of all of your programs. Put campaigns in place now to increase Quality performance for reaching 2018 HEDIS goals.

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Presentation @ RISE VBC: Effective Collaboration Strategies Between Payer & Provider

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