HEDIS and The Health Plans
Health Plan
works to promote preventive health care and to improve chronic care for their
members. The effectiveness is measured by Healthcare Effectiveness Data and
Information Set (HEDIS), a set of quality improvement indicators set forth by
the National Committee on Quality Assurance (NCQA). HEDIS results are used to
compare health plans both statewide and nationally. The goal is to reach the
national Medicaid 90th percentile on all measures, which will result in
bringing more patients to the providers.
Innovative
programs created by health plans around the country are credited with boosting
immunization rates to unprecedented levels, especially among infants and older
children. But what makes these programs, which go by such names as
"Getting Bigger," "Great Expectations for a Healthy Baby"
and "Health Ride," so successful?
There are five
typical characteristics.
First, they determine how many eligible children
are up to date on immunizations at their second birthday, even if they suspect
the rates will be low.
Second, they identify the factors associated with
low coverage.
Third, by assessing their immunization activities
and using criteria such as Health Plan Employer Data and Information Set
(HEDIS) to collect, track and document data, they identify missed opportunities
to vaccinate.
Fourth, these plans demonstrate commitment to
developing innovative interventions designed to raise immunization levels.
Finally, they are committed to working toward the
federal Childhood Immunization Initiative's goal for 2000 that at least 90
percent of children receive the recommended series of vaccinations by their
second birthday, and to ensuring continuous accreditation of health plans by
organizations such as the National Committee for Quality Assurance (NCQA).
Understanding how HEDIS effects the Health Plans is key.
However, for the Health Plan to meet the HEDIS score, they require a
partnership with the PCP. Does the provider understand how HEDIS works at the
primary care level? Is the PCP aware of
the incentive ? Does the PCP fully understand what is required to qualify the
measure?
AccuChecker OnLine CLASSIC is an Internet database subscription service
with procedures, diagnoses (ICD-9 and ICD-10) Medicare fee schedules using
RBRVS tables and coding techniques. Today , AccuChecker Online has a HEDIS
Module and PQRS Module to help physician qualify for each Measure.
For a Free Trail or Webinar, contact our
office.
For more details, please call :
305-227-2383 or 1-877-938-9311
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