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Top 5 Tips to Improve Your HEDIS Measures

Recordkeeping has been and will always be the cornerstone of excellent health care. Knowing a patient’s medical history and other medical information is essential to being able to provide optimum services because so much of what a physician does is based on what has already been done or what has already occured. Because recordkeeping is so essential, the medical field is always working to improve it.

The Healthcare Effectiveness Data and Information Set is a tool that enhances recordkeeping. It helps to monitor the patient care and ensure a health plan is functioning properly and effectively. The main goal is that HEDIS produces and uses information to monitor preventative care and quality of care However, HEDIS measures are only as effective as the people using the system.

Common Issues

As with any system of keeping medical records, HEDIS is subject to human error, which will mess up results and information. There are actual some common errors that occur. Providers need to be aware of the issues so they can be corrected and HEDIS can be most effective. Here are some of the Issues seen most often:

  • Documentation errors
  • Measures in the system do not match actual information
  • Claims were incorrectly coded or missing coding
  • Information will not transfer to a new PCP
  • Member enrollment is not continuous

Many of these issues are difficult to correct. For example, HEDIS measures not matching with real world information is something that requires a system overhaul, which is costly and time consuming, but it can be done. However, some of the issues really cannot be fixed. For example, members not being continuously enrolled is an unfixable issue because members are responsible for their own coverage.

All is not lost, though. There are issues that can be corrected and can make using HEDIS more effective and helpful. To begin with, providers and staff have to focus on accurate and complete recordkeeping. Ensuring proper coding is used, double checking information when entered and ensuring all information is entered could fix many issues.

Making HEDIS More Effective

When making the best use of HEDIS, a facility needs to focus on three main practices. These best practices are executing effective interventions, collecting and maintaining data sets and engaging providers and patients.

Executing effective interventions allows for a complete foundation for the whole HEDIS. It is using HEDIS measures to pinpoint the patients who  need services and then ensuring they get them. HEDIS is great at letting facilities and providers know when a patient is due for a preventative service, but unless this is acted on, it is useless.

Data collection and maintenance, as mentioned, is essential. Without the right input of information, HEDIS cannot help a facility to improve and function properly. This means putting in all the required information and including details.

Engaging providers and patients puts the whole system to work. HEDIS is designed to help ensure patients are getting the care they need. If everyone is not engaged in working with the information provided by the system, then there is no real point to using it.

In Conclusion

It all comes down to using HEDIS measures more effectively and efficiently in order to get the most from it. When facilities, plans, providers and patients are all on board, HEDIS can serve a very important purpose in increasing health care value and effectiveness.