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Dec 1, 2019

Hints for HEDIS

As the year comes to a close, it’s time to plan for 2020. The case has been made for taking a year-round approach to improve your HEDIS outcomes. Use the tips below to jumpstart your success.

Create your calendar by documenting events and deadlines related to HEDIS. Use the questions below, separated by each quarter, to help guide your strategy.

Quarter 1

  • How are you getting patients in to see their providers?
  • How are you engaging patients who ended the year with open gaps?


Your October 2019 PQIP Detail Report (the last gaps in care report of the year) is a great resource to check for members who failed to receive screenings.

Quarter 2

We recognize and appreciate all of the time and resources needed for “chart chase” season. The new gaps in care reports for the current year should now be available. Think about the following:

  • What are you doing to outreach to patients with gaps?
  • Are you using the gaps in care data to do pre-visit planning?
  • Are you using all of the “quality and health maintenance flags” in your Electronic Health Record?
  • What is your strategy for gap closure, tracking, and reporting?

Quarter 3

At this point, you should have a robust set of data for the current year, with several months of reporting completed. Focus your action now by determining the following:

  • How could you make your provider reporting even better?
  • What is your patient engagement strategy?
  • How are you handling incomplete/missing data rework?
  • Are you reshaping your focus according to your data?

Quarter 4
It’s essential to use your resources wisely to determine which gaps you can close by year-end.

  • Do you have a fourth quarter push strategy in place?
  • Does your reporting support your strategy?
  • Are you collaborating with the payers to get historical data on patients, for example, which patients have been historically compliant in the past?

The more preparation you do on the front-end, the better your results will be. Preparation means utilizing data made available to you (monthly gaps in care and summary reports) and incorporating this data into your clinical workflows.

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