Introduced in 2015, the HEDIS® electronic clinical data systems (ECDS) reporting standard provides payers with a method to collect and then report structured electronic clinical data for HEDIS quality measures. The goal is to remove gray areas from written specifications, streamline data acquisition, and foster interoperability for more real-time, actionable data. Reducing the burden of manual chart review can also give plans more time to focus on prioritizing member outreach, reducing treatment costs, and closing gaps in care. This is an important step in improving member outcomes.
Screening rates are an essential aspect of many HEDIS measures, and increasing these rates improves both member health and plan quality scores, as well as reducing healthcare costs. Regular cancer screenings, for example, can catch some of the most fatal cancers, such as colorectal cancer. In fact, regular colorectal cancer screening can reduce mortality by catching precancerous polyps or detecting cancer at its earliest stage, when treatment can lead to a 91% survival rate after five years. However, 31.2% of adults 50–75 years old report not being up to date with recommended screenings, according to the most recently available data—and as of 2021, the U.S. Preventive Services Task Force recommends screening for those 45–49 years old as well.
Currently, the colorectal cancer screening measure (COL) can be reported using either administrative data (the “administrative method”) or administrative data supplemented with medical record review for a sample of members (the “hybrid method”). However, under requirements from the National Committee for Quality Assurance (NCQA), plans will have to transition to the electronic clinical data systems (ECDS) method as of Measurement Year (MY) 2024, if they have not already.
With COL set to become an ECDS-only measure shortly and other measures to follow, below are four strategies a plan should consider to optimize their HEDIS scores and efficiency:
- Don’t forget to save: Save your chart review results year over year as “pseudo claims” in your HEDIS reporting tool so that you can use the data again. This would be considered a supplemental feed and would therefore require auditor review.
- Be proactive: Perform off-season chart review on your members and use this data as a non-standard supplemental source. This data would also need to go through auditor validation, but offers a way to bridge the gap in the first year of ECDS measurement.
- Collaborate: Work with your providers to get the historical data on their members. Make sure your providers understand why this shift is happening and collaborate with them to select the right metrics, benchmarks, and reporting to properly engage in closing any gaps.
- IT is key: Bring all stakeholders together as early as possible. Talk to your IT team about creating a repository to house historical screenings that aren’t coming from claims to ensure future access to this valuable data.
As NCQA noted in a May 2021 report on the future of ECDS, plans still struggle with standardizing data capture at the point of care and efficiently sharing information between healthcare systems, which makes the transition to ECDS-only reporting more challenging. However, once these challenges are overcome, plans will reap the benefits of improved interoperability and additional resources to devote to improving member care.
Learn more about this and other successful strategies for proactive gap closure and digital clinical measurement from Cotiviti’s on-demand webinar wrapping up the MY 2021 HEDIS season.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).