You can hear the shouts of joy when the HEDIS® season is drawing to a close! The countdown to the June 15th deadline to submit HEDIS 2018 data just wrapped up. Undoubtedly, there was no shortage of details to ensure submissions were accurate, locked on time, and approved by auditors. While plans and providers across America are jumping for joy celebrating the end of this year’s HEDIS data collection, it’s a good time to sit back and reflect on what made this season different, how Ciox delivered one of its best HEDIS seasons ever, and why it’s not too early to start thinking about 2019.

What made 2018 HEDIS different than previous years?

Last year, the National Committee for Quality Assurance (NCQA), the private, 501(c)(3) not-for-profit organization dedicated to improving health care quality which governs and oversees HEDIS, issued new guidance and changes for the 2018 season.  There were several first-year measures. Major changes included:

  • New and revised behavioral health and chemical dependency measures
  • New transitions of care measures calculations using the hybrid methodology
  • New guidelines for measures using Electronic Clinical Data Systems (ECDS)
  • Increased use of stratification
  • Inclusion of telehealth as appropriate follow-up care in several behavioral health and chemical dependency measures

In addition, the HEDIS submission timeline was more aggressive with an earlier medical record review validation (MRRV) deadline as well as an earlier than planned lock deadline. Coupled with uncertainty over stability and insurer participation in the Affordable Care Act (ACA) and the Centers for Medicare & Medicaid Services (CMS) decision to extend the Medicare Advantage (MA) and Risk Adjustment Payment System (RAPS) submissions to support plans and communities impacted by extreme weather in 2017, this year’s HEDIS season was most eventful!

Ciox performance during 2018 HEDIS season

As the result of important planning, collaboration and communications actions, Ciox helped its customers achieve a very successful HEDIS season. Our teams across the business huddled together every day and did what it took to get that last chart retrieved. Ciox also invested in detailed training that led to the improved capture of targeted documentation and medical charts.  We experienced a 27% increase in requested volume, 49% increase in retrieved volume and a 14% increase in yield over 2017. When excluding short-term projects, the numbers improve to a 90% increase in requested volume, 112% increase in retrieved volume, and a 1.5% improvement in yield over 2017.

This year, we delivered better performance for our clients and managed a dramatic increase in workload for Optum, part of United Healthcare. One of our key stakeholders at Optum said, “This is my third HEDIS season and the best one by far.” Her team couldn’t say enough positive things about their partnership with Ciox, how hard we worked, and the transparency we provided throughout the process.

It’s not too early to start thinking about the 2019 HEDIS season

While plans are already switching gears and are getting ready for the 2018 Medicare Risk Adjustment (MRA) season, it’s not too early to start thinking about how to get ahead of the curve for the 2019 HEDIS season.  In a few short months, plans will begin to determine the size and quantity of their 2019 HEDIS requests and will evaluate the resources needed to fulfill the information required for HEDIS submissions.

While some health plans work directly with providers to obtain the medical records, others work with service providers, such as Ciox Health, to fulfill record requests for HEDIS reviews. Ciox has begun to work with many plans who are beginning to take a year-round approach to quality data collection.  Ciox can take the burden off of plans to help review new measurements, specifications, and timelines while making plans to update and enhance data collection and workflow processes.  A service provider such as Ciox can help health plans manage the large volume of requests while reducing the burden and abrasion, ensuring a smooth and timely delivery of medical records.  Please contact Ciox today – we’d be happy to get the conversation started!

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