Introduction to HEDIS 2015 - partnershiphp.org · Introduction to HEDIS 2015 . Tegan Spencer ....
Transcript of Introduction to HEDIS 2015 - partnershiphp.org · Introduction to HEDIS 2015 . Tegan Spencer ....
NORTHERN REGION Presented by:
Introduction to HEDIS 2015
Tegan Spencer Quality Improvement Project Coordinator
Lauri Stevenson, RN Performance Improvement Clinical Specialist
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Why are we here today? HEDIS Overview Regionalized Reporting
Medical Record Collection Process Timeline Resources
HEDIS Overview
What is HEDIS? Healthcare Effectiveness Data Information Set Measures the quality of care provided to our members
Why is it Important? Emphasizes the importance of preventive care and follow-
up visits with primary care and specialist Encourages accountability and opportunities for
improvement in the quality of healthcare Required activity by the State Rates are publicly reported
What are the measures?
Types of HEDIS measures:
Administrative Data collected through claims and/or
encounter services billed
HEDIS measures address:
Musculoskeletal Conditions Medication Management Access/Availability of Care Utilization
Hybrid Data collected from both claims and/or
encounter services billed and supplemented with data collected from the Medical Record Chart
Prevention and Screening Respiratory Conditions Cardiovascular Conditions Diabetes
What are we looking for?
When collecting medical records, our vendor will be looking for specific information to satisfy the measure(s).
Some examples of what they will be collecting are:
History and Physicals Progress notes Lab reports OB flow charts Immunization and Disease Registries BMI/ growth charts
Challenging Measures Administrative Annual Monitoring for members on Persistent Medication Children and Adolescents Access to Primary Care Practitioners 12months – 19 years
Hybrid Immunization Status Comprehensive Diabetes Care Eye Exams Performed
Reflecting on HEDIS Reporting Populations Eastern (Solano, Yolo, Napa Counties) Sonoma Marin Mendocino
New Counties reporting HEDIS 2015; Modoc, Lassen Shasta, Siskiyou, Trinity, Humboldt, Del Norte
Contracted with a new Medical Record Retrieval Vendor
HEDIS Regionalized Reporting
New Regional Reporting Structure
Region Counties
Southeast Napa, Yolo, Solano
Southwest Marin, Sonoma, Mendocino, Lake
Northeast Modoc, Lassen, Shasta, Siskiyou, Trinity
Northwest Humboldt, Del Norte
Questions so far? We’ve gone over: What HEDIS is. What types of measures we report on. What we will be looking for in your records. Examples of challenging measures. Regionalized reporting.
Medical Record Collection Easy as 1 – 2 - 3
Medical record collection can be done 3 ways.
1. Fax or Mail in Records 2. On-site visit to collect records 3. Remote access to your EMR
HEDIS 2015 Timeline
February March April May June July August
Vendor Schedules
medical record collection
Primary Medical Record Collection and Review 2/15/15 – 5/15/15
Medical Record Collection and Review stops
5/15/15
PHC provides vendor with list
of records to collect
Additional data collection to determine county level performance
Secondary Medical Record Collection
HEDIS Results locked in
6/16/2015
HEDIS 2015 performance shared with Provider Network
Medical Record Review Validation Audit
5/19/15-5/29/15
Questions? The HEDIS team is available to answer questions by phone,
fax or email. Our contact information is: Southern Region: (707) 863-4282 Northern Region: (530) 999-6828 Email: [email protected] Fax: (707) 863-4314
HEDIS 2015 Medical Record Collection Processes & Vendor Introduction- (Content is the same on both dates) Date: Jan 14, 2015 1:00 PM - 2:00 PM PST & Jan 22, 2015 1:00 PM - 2:00 PM PST
Registration URL:https://attendee.gotowebinar.com/rt/8379442248011970562
HEDIS 2015 Refresher – HEDIS Processes and timeline-(Content is
the same on both dates) Date: Feb 11, 2015 & Feb 17, 2015 1:00 PM - 2:00 PM PST
Registration URL:https://attendee.gotowebinar.com/rt/5085220748799904258
Where can you get more information?
HEDIS Website: http://www.partnershiphp.org/Provider/MC_HEDIS.htm
NCQA website for more details on HEDIS: http://www.ncqa.org/HEDISQualityMeasurement.aspx
Contact us! eMail: [email protected] Southern Region Phone: (707) 863-4282 Northern Region Phone: (530) 999-6828