The countdown to the HEDIS® 2019 reporting deadline has begun. Are you on track? Our Cotiviti experts are here to share their insights on effectively managing your measurement and reporting process in our monthly blog series, “from the HEDIS 2019 trenches.” Here, Jamison Gillitzer, product manager for Cotiviti’s Quality and Performance solutions, starts us off on the right track.
Where should health plans be in the HEDIS process now that we’re all back from the holidays and digging back in?
Hopefully, you’ve already completed a test run before the holidays so you know that your data files are in good shape. If you haven’t, pay close attention to the data after your production run is complete. If you did complete a test run, this month you should be focusing on getting your production run ready to go. This might require mapping your supplemental data files, gathering the final provider location data, or waiting for any additional claims files. If your health plan submits a CAHPS® survey or Qualified Health Plan (QHP) survey for the Health Insurance Marketplace, you should be working with your HEDIS software vendor to get the data extracts required for those surveys to your auditor for validation. Your auditor should validate the files no later than January 31.
What are some challenges facing health plans at this point, and what recommendations do you have to overcome them?
Right now, health plans should have their data mapped to their vendor’s layout, particularly if you’re using a new vendor or if your vendor has made any changes. Make sure that you’re following your vendor’s guidelines for how much data you should send so that your measure results are complete.
Health plans should take advantage of any validation tools offered by their vendor. For example, Cotiviti has a Data Audit Tool to check the results of each file, and clients should use the reports as a guide to ensure the format is correct. You should also be checking the file sizes to ensure consistency from last year’s data runs—if a file is significantly larger or smaller than last year, make sure you know why. Getting your data right will help ensure a smooth production run.
What other some other common difficulties?
Health plans also struggle with their survey sample frames. Maybe they’re unsure about which survey measures they need to report or which data is required to produce the extract. If that’s the case, you should work with both your vendors and your auditors to resolve any uncertainty. If you need custom fields on the extract, your vendor can help you add them. If you’re unsure how to populate a QHP field, rather than leaving it blank, talk to your auditor about how you can get that information.
Another suggestion is to send a test CAHPS file to your vendor for validation before sending the final file. Cotiviti had the CAHPS measures certified by our December software release, giving health plans time to produce a test file and validate its results before the final file is due.
What are some next steps health plans should be considering?
January is the best month to complete your production run and pull samples. Be sure to work closely with your auditors through this process. They can help validate measure rates and sign off on your samples. Having their validation will help with any on-site questions they may have later in the season. Auditors are there to help you in the submission process, not punish you.
After you have your samples pulled and chases assigned, review provider location data closely to ensure accurate addresses and appropriate chase locations. There is no need to visit that ENT specialist for a well child visit or that chiropractor for the diabetes measure.
Tell us a little bit about your role here at Cotiviti. What keeps you busy during the HEDIS season?
Primarily, I focus on all things HEDIS and P4P (pay-for-performance). This means all measure logic, certification, and application updates needed to successfully submit each year. I also support our clients directly, helping address questions on our software and processes. I want to empower them to learn the features that can best support them during their submission season.
Stay tuned in February for our next report “from the trenches.”
With a unified view across measures, Cotiviti's Quality Intelligence solution drives a level of efficiency that enables proactive year-round measurement and reporting, allowing health plans to continuously refine their quality improvement programs and achieve better results. Learn more from our fact sheet.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).
