The HEDIS® 2019 season is close to halfway done. Are you on track for the reporting deadline? Jenna Fitcher, product director for Cotiviti’s Quality and Performance solutions, discusses best practices for tracking retrieval, abstraction, and measure rates in the latest edition of our blog series, "from the HEDIS 2019 trenches."
Where should health plans be in the HEDIS process now that we’re about halfway through the season?
At this point in the season, clients should have their production runs complete, samples pulled, chases identified, and all provider location data clean-up complete. They should also be about halfway through their retrieval efforts and have started abstraction. With around seven weeks left in the hybrid season, health plans need to work efficiently and effectively to see improvements in their rates before final submission.
What are some challenges facing health plans at this point, and what recommendations do you have to overcome them?
One of the challenges we see with our clients is the ability to appropriately track progress in their retrieval and abstraction processes. This includes identifying:
- How many chases are complete
- How many chases are open
- What samples need new or additional chases
- What records have come in but aren't abstracted yet
- What hybrid measure rates look like and how you are tracking toward goals
- Which measures are falling behind on retrieval or abstraction rates
- Which measures need additional over-read to ensure rates are accurate
Knowing the answers to these questions is key to having a successful season. By tracking your retrieval and abstraction efforts on a weekly basis as the season progresses, you will see what trends are appearing in your measures and even in your team. The answers will help you understand whether you need to add more staff, whether your provider networks need to intervene to obtain records from their offices, and whether your retrieval partners have been successful in obtaining records.
Any other common difficulties?
One particular difficulty in abstraction is monitoring the performance of your team. It’s hard to let someone go, but if a team member is truly struggling to understand the measures and isn't improving, it might be a conversation worth having. Alternatively, you might see that an abstractor is stronger in certain measures than others, so dividing the measures among the team could be a better strategy to see an improvement in your abstraction quality scores.
Can your measurement and reporting software vendor help?
Your vendor should be able to recommend reports that will give you these answers. Cotiviti has several retrieval and abstraction reports that can tell you which provider locations have been visited and what the retrieval rates are for those locations, which new chases have been added or samples that have referrals, how many chases are closed and open by measure, and what your day-to-day measure rates look like.
It’s important to track these items to know where you might be falling behind, so you can intervene before abstraction rates need to be submitted to your auditor.
Looking for help with medical record retrieval? Learn how Cotiviti’s Medical Record Retrieval services streamline retrieval, aggregation, indexing, and storage while enabling plans to achieve or exceed their retrieval targets with provider weighting algorithms that avoid unnecessary effort.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).