Three Key Benefits of HEDIS Score Optimization for Payers
- July 3, 2019
The Healthcare Effectiveness Data and Information Set (HEDIS) was created by the National Committee for Quality Assurance (NCQA) to measure the quality and performance of health plans. The implications of HEDIS scores reverberate throughout quality evaluation, reimbursement, and incentives, as well as plan enrollment and patient satisfaction.
When HEDIS scores are optimized payers can expect these three key benefits:
- Insight into gaps in care
Untracked data is unactionable data! Proper tracking gives you insight into gaps in care and helps you to collaborate with your providers to address the specific needs of the communities you serve. Tracking your HEDIS score enables you to specifically identify areas of improvement and increase the quality of care in a more targeted, efficient way.
- Competitive advantage
As consumers are shopping around for health plans, public perception can be integral in their decision-making process. Employers and purchasers alike are reluctant to purchase coverage if they don’t see the value. As your plan’s quality increases, you’ll be able to boast a higher HEDIS score and become more attractive to purchasers.
- Star Rating boost
CMS Star Ratings are determined by a variety of performance measures, one of the biggest being your HEDIS scores. By improving that score you also increase your Star Rating, making your plan more attractive to purchasers. Plus, ratings 4 and above qualify for incentives!
Remember that there’s a wealth of benefit in reporting your HEDIS scores. The best way to optimize your scores is to utilize effective population management software that drills down to the type of detail that affects change.
SpectraMedix is committed to supporting payers as they transition to value-based care. HEDIS measures are one avenue that enables payers and their providers to improve patient outcomes and administer a higher standard of care.
Written by Alexa Rivera