Preparing for HEDIS 2020: Engaging providers for a successful year.

Beth Hickerson, Healthcare Transformation Consultant Healthcare Consulting

As we near the end of the 2019 HEDIS measurement year, health plans and providers are busy making their final efforts to close gaps-in-care. This is an incredibly stressful time for providers, who are being asked to squeeze in as many visits and services as possible before the end of the year. Health plans are also receiving their first look at the HEDIS 2020 technical specifications, including a number of new measures that are being added to an already unwieldy list of HEDIS measures. Successfully communicating with providers about HEDIS 2020 can set you up for a successful year, but it must be done correctly to get the best results.

Before sending out the next blast email or provider newsletter, there are a few things you should consider when engaging with providers regarding the HEDIS 2020 changes. If you want to succeed in working with practices, you first need to understand where they are coming from. This will allow you to develop a successful provider engagement strategy.

Practices serve patients first.

While providers recognize the importance of clinical best practices, at the end of the day, their primary focus is on caring for patients and ensuring they offer recommendations that are best for each individual. All of the documentation that is needed for HEDIS and other clinical measures can sometimes feel like a heavy weight and they may struggle to see the connection between HEDIS improvements and providing excellent patient care and patient experience. We have outlined some key tactics for engaging with providers to accelerate success and connect to their objectives in this infographic.

Reimbursement and incentives get the practice’s attention.

If health plans are asking providers to do extra work to track a new measure or collect specific data, it is only fair to pay them for their time. When you think about it, providers are not any different than health plans in that sense. Health plans focus their attention on the measures that will earn them higher quality ratings and bonus payments from Medicare, Medicaid, and commercial customers. Likewise, providers will direct their limited resources toward the measures that earn the highest reimbursement. Clearly outlining reimbursement and incentives will help engage practices as they move in to HEDIS 2020.

Consistency promotes compliance.

Practices are more likely to follow clinical measures when it can be applied to the majority of their patients. When payers align their measures, it creates a common standard for providers that increases the likelihood of compliance – health plans that can identify these easy-to-capture measures make it easier for providers to comply and improve their own chances of a positive outcome.
For example, NCQA changed the standard for Controlling High Blood Pressure to <140/90 mm Hg across all of the population groups for HEDIS 2019. This is consistent with the Medicare MIPS measure for Controlling High Blood Pressure, which is also <140/90 mm Hg. Many practices are using Controlling High Blood Pressure as their required MIPS outcomes measure because it is easy to capture. Identifying this overlap can have a positive impact on the health plan’s HEDIS 2020 results.

EHR vendors are driving the changes.

While health plans are looking to providers to implement the changes for HEDIS 2020, the practices are looking even further downstream to their EHR vendors. It can take months for EHR vendors to get their systems up-to-date to reflect the latest HEDIS 2020 specifications. Providers are not able to start modifying workflows or reporting data until their EHR vendor completes the update. Health plans need to be aware of these constraints and set realistic timelines when communicating with providers.

Practices can be slow to adopt.

It has been said many times, but it is still true. Practices are focused on what they need to do today, not next year. As much as they would like to be able to plan ahead for HEDIS 2020, they don’t always have the resources to do so. Even if health plans provide a heads-up on the proposed new measures, practices will not likely change their behavior until it is necessary. This also ties back to their dependence on EHR vendors to update their systems before they can make any changes.

Practices appreciate a real-world perspective.

While there are many advanced technologies available, they don’t reflect the experience of most practices. It is important to acknowledge the reality providers live in when communicating about HEDIS 2020 or other programs. Your strategy should involve an empathetic, but enthusiastic approach – focus on areas that can impact the majority of providers and patients while keeping in mind the technology they have access to.

Data drives change in practices.

Providers always appreciate when data is used to make a point. It can help show the impact of a change in workflow or clinical practice. Often, health plans write articles with generic statements about improving quality and reducing cost. But how will the change improve quality? How much will it save in the next year, or five years? The more health plans can share actual projections, the more they can grab the attention of practices and inspire them to make the changes.

Preparing for HEDIS 2020

The measurement year for HEDIS 2019 is almost over. With only a short time left to provide services, the main way that health plans and providers can impact the measures is through data collection and reporting. Many people think that Medical Advantage’s practice consultants go into practices and change their clinical protocols, but that is rarely the case. If a practice is scoring poorly on a measure, it is almost always because they are not documenting it the way they are supposed to, or the EHR system is not properly capturing or reporting the data.
Medical Advantage has an active consulting practice. We work with physician offices to optimize their EHR use and maximize performance on the practice’s selected clinical measures. Health plans can leverage our existing relationship with practices, which in many cases includes in-practice support with our consultants working in provider offices. We can help connect the dots and make sure health plans get the data they need for HEDIS 2020.

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