Although health plans annually perform both Risk Adjustment reviews and HEDIS quality abstractions, there is significant duplication of efforts when obtaining the charts needed for both programs because there is often little communication between them. Imagine the frustration at a provider’s office while they fax the same records to the same health plan, but to two different fax numbers.
A recent conversation with a Vee Technologies client revealed his frustration after learning the two departments, Risk Adjustment and Quality Metrics (HEDIS), had requested, received, and uploaded nearly 60% of the charts from the same providers for the same patients. Once would have been sufficient. Unfortunately, these charts were in separate databases not shared between the two departments. And since no sharing occurred, there sat nearly 10,000 duplicate records.
Concerns with this model to consider:
Would it cost additional money to gather HEDIS year-round and during HEDIS season?
Answer: No - The same number of HEDIS measures will be collected annually whether collected year-round or during HEDIS season.
Will HEDIS data be collected that isn’t needed by the health plan?
Answer: No - Health plans generate reports of missing HEDIS data regularly to share with their providers. With access to these reports, only data needed would be captured.
Where will data be stored until ready to upload for HEDIS season?
Answer: Not determined. This will require a review of the health plan’s software capabilities or perhaps research into a third-party software program.
Will we need to employ twice as many people to cover both Risk Adjustment and HEDIS reviews?
Answer: Vee Technologies has skilled clinicians and certified coders capable of performing both reviews with proper training. Staff would have to be adjusted based on the increase in volume of reviews.
Vee Technologies currently offers both Risk Adjustment reviews and HEDIS abstractions as one of its many services. Creating a workflow incorporating a seamless transition from Risk Adjustment reviews to HEDIS data collection can be invaluable to organizations.