from the trenches podcast: prepping for HEDIS® 2018 production

In Cotiviti’s new “From the Trenches” podcast, we’ll be digging deep into the challenges facing health plans from month to month during the HEDIS 2018 season, and what they should be doing to prepare for the next step of the process. We’ll also look at the changing role of the quality department and how quality improvement has evolved beyond the annual HEDIS reporting process.

In our premiere episode, we talk with Jenna Fitcher, product director for Cotiviti’s quality improvement solutions, and Geetha Bhatraj, director of data program management. Listen here:

From the Trenches is a new podcast from Cotiviti, a leader in healthcare data analytics, exploring the latest trends in healthcare quality and performance analytics, risk adjustment, payment integrity, and payer-provider collaboration. Check out all our episodes in your browser, or subscribe on your smartphone or tablet with  Apple Podcasts, TuneIn, Google Play, and Stitcher.

About our guests: 

Jenna Fitcher's primary responsibility is ensuring our solutions meet clients’ needs in support of HEDIS, Star Ratings, and other quality reporting initiatives. She also works to develop and maintain Cotiviti’s strategy and roadmap for ongoing initiatives.

Geetha Bhatraj has been with Cotiviti for more than nine years in various roles under data operations. She has worked with more than 50 health plans' data, processing claims for over 30 million lives. Geetha enjoys working with healthcare data analytics to drive improvement in quality of care.

Podcast transcript

Tell us about your roles at Cotiviti and what keeps you particularly busy during the HEDIS season.

Jenna: NCQA's HEDIS specification changes really keep the product team busy from year to year. We're responsible for making sure all of those changes get into every aspect of our tool, from measure certification, which we're responsible for on an annual basis, to all of the application reporting changes and updates that our customers use to trend, analyze, and report on.

Geetha: It's the peak of the HEDIS season, and most of our clients are busy pulling out their samples, reviewing them, giving them to their chart reviewers, and starting the retrieval and abstraction phase. There is also the administrative part of the measures, which they will be reviewing, making sure there are no surprises, making sure the data is good, and getting the data audited by the auditors.

What are the top priorities that health plans have been working on during January, and what are the major difficulties they’re facing?

Jenna: Their top priorities are their annual roadmap that's used to outline all of their data nuances and vendor information that they're using for the season, along with production and CAHPS, the survey measure runs, reviewing rates, drawing production samples, executing chase logics, and training their staff on any new changes that came from this reporting year as well. It's a juggling act for all of these items, managing these initiatives in a timely manner so that nothing derails and timelines are met—and the train keeps on trucking for the HEDIS season.

What are some tips to ensure that your data is ready for the production run?

Geetha: Before getting into the production season, we highly recommend that all clients do a test run to make sure their rates are comparable to their prior year's HEDIS submission rates, and when they're reviewing their rates, to review specific measures to make sure their inpatient logics are set up properly, their service dates are set up properly, and provider specialty has been set up properly, etc. The rates are an indication to point out any data mapping misses. We really recommend reviewing the data before it goes into production. The other important item is to have the staff trained to ensure they catch any data misses.

Once production rates have been approved, what are the next steps for drawing samples?

Geetha: There is a little bit of prep work involved before we pull samples and chases, including the sample configuration and chase configuration, which we would be receiving from the client. The configurations specified in those configuration sheets will drive the hybrid process, so it's really important to make sure the clients provide the right configuration to Cotiviti so that they would be pulling samples on the right products. If we miss pulling samples on any product, that would impact their HEDIS submissions. After the client provides the sample and chase configuration, it's always safe to have it reviewed by their auditor to make sure they are meeting their reporting needs, and give it over to us.

After providing the sample and chase configuration, and Cotiviti completing pulling samples and chases, it's important for the client to review the samples and chases and sign off on the sample sizes so that Cotiviti can move further in the stages of processing HEDIS data.

Let’s look ahead to February. What challenges will health plans face during that month?

Jenna: The next step is reviewing the results so that provider location data is accurate to ensure that as the plans start requesting medical records, their location data and provider information is clean and complete. This to helps reduce provider abrasion.

HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA).

Podcast music credit: "Inhaling Freedom" by Nazar Rybak, via HookSounds.