The NCQA’s phased approach to enable a new era of digital HEDIS® presents the industry with new opportunities for reporting accuracy, strategic and proactive interventions to maximize performance, and streamlined HEDIS operations for quality professionals. However, the path to becoming fully digital may present some challenges.  

The traditional HEDIS method involved manual abstraction of data from medical records. The NCQA has offered health plans a guide for the digital transition and is recommending a gradual transition using a hybrid model where every year one or two measures will go digital. The NCQA aims to be completely digital by 2030, although this date is not firm.

The Complexities of the Digital HEDIS Transition

Transitioning to digital HEDIS poses significant challenges for health plans, primarily due to the complexity of integrating diverse data sources. Digital HEDIS requires the consolidation of various types of data—including electronic medical records (EMRs), health information exchanges (HIEs), state immunization registries, pharmacy records, claims data, and supplemental provider information—into a single, cohesive platform. Ensuring that these different data types are compatible and meet the specific file specifications mandated by the National Committee for Quality Assurance (NCQA) is a substantial technical undertaking. Many health plans may not have the sophisticated team of data analysts and developers necessary to manage this integration effectively, leading to potential inaccuracies, delayed reporting, and reduced performance.

Another challenge is the need for the technology and infrastructure to support digital HEDIS processes. Health plans must adopt advanced analytics engines and data management systems capable of processing large volumes of data quickly and accurately. Beyond data processing, it’s imperative for plans to use analytics for prospective, ongoing monitoring that drives performance improvement initiatives.

Unburden Your HEDIS Reporting with UST HealthProof's High-Speed Data Engine

UST HealthProof offers a transformative solution to these challenges with its high-speed HEDIS data engine. By leveraging advanced technology, health plans can overcome the limitations of traditional reporting methods and embrace the future of digital HEDIS.

Embrace a Holistic Approach to Data Management

With UST HealthProof's HEDIS engine, all data sources are compiled into a single, integrated platform. This may include data from Health Information Exchanges, state immunization records, EMR data, pharmacy data, claims data, and supplemental data from provider offices. By linking as many data sources as possible, the platform provides a comprehensive view that aligns with NCQA-certified rules and accurately rates each HEDIS measure.

Accelerate Data Processing and Real-Time Insights

One of the standout features of UST HealthProof's solution is its ability to process two million member records within one business day—well above the industry norm, which can take days. This rapid processing allows health plans to generate timely reports that reflect the most current state of HEDIS performance. With monthly prospective analyses, plans can proactively identify areas for improvement and initiate targeted interventions without delay.

Drive Performance Improvement Through Actionable Analytics

UST HealthProof’s solution doesn't just process data; it transforms it into actionable insights. For example, if the data indicates low measure performance in the Effectiveness of Care domain, specific campaigns can target improvement initiatives for that specific measure. For the colorectal cancer screening measure, if low screening rates are detected, an outreach campaign can be triggered to remind members via email or text to complete their tests or register to receive an at-home test kit. These targeted reminders are highly effective and address common gaps.

Similarly, for Access to Care measures, insights might suggest the need for provider education or incentives. The integration with prospective risk adjustment allows for coordinated outreach to providers to close both diagnosis and HEDIS gaps, suggesting next-best actions.

Empowering Health Plans with User-Friendly Tools

Understanding that not all health plans have large data teams, UST HealthProof's platform offers pre-built, self-service reporting dashboards. Plans have access to their data whenever needed, promoting transparency and control. The abstraction tool seamlessly toggles between retrospective (official HEDIS submission data) and prospective views (monthly monitoring data), ensuring there are no surprises when it's time for submission.

Preparing for the Future of HEDIS

Adapting to digital HEDIS may initially seem daunting, especially with the need to integrate various data types and ensure correct file specifications. However, partnering with a sophisticated HEDIS vendor like UST HealthProof can ease this transition. The platform provides end-to-end support—from data abstraction to ongoing monitoring—and offers actionable ways to improve performance. This holistic approach ensures that health plans can collect, analyze, and report HEDIS data accurately and efficiently.

Impact on Star Ratings and Quality Outcomes

Strong performance on HEDIS metrics significantly impacts a health plan's overall Star Rating. HEDIS accounts for 17% of the 40 Star measures used by the Centers for Medicare & Medicaid Services (CMS). Investing in HEDIS improvement initiatives is not just beneficial but essential. By enhancing HEDIS performance, health plans can positively influence their Star Ratings, leading to increased incentives and improved member satisfaction.

Conclusion

Navigating the complexities of HEDIS reporting requires innovative solutions that address data integration, timely processing, and actionable insights. UST HealthProof's high-speed data engine empowers health plans to meet these challenges head-on, ensuring they stay ahead in quality and performance. As the industry moves toward full digitization, now is the time for health plans to adopt robust, holistic approaches to HEDIS data management and analytics.

By embracing these innovations, health plans can not only overcome current challenges but also position themselves for future success in delivering high-quality care.