Written by Prashant Patel.
As one of the nation’s top HEDIS agencies, CareNational is always committed
to providing the finest service possible to our candidates and our clients.
This includes continuing education through interactive conversations with
contacts from both the client and candidate perspectives. As the MY 2023 HEDIS
(Healthcare Effectiveness Data and Information Set) season
approaches, CareNational has dedicated a series of blogs to help leaders and
staff-level workers involved in the HEDIS process.
For many Managed Care Organizations, some pre-HEDIS activities are already
underway. Additionally, the bulk of the work, Chart
Abstraction and Over-Reading, is right around the corner. I wanted to
address the substantial role that outside vendors play during the HEDIS season.
There are many vendors out there that provide different HEDIS services.
Identifying what exactly is needed and who can provide it is paramount, as some
vendors are involved in one or more phases of HEDIS: Data Validation,
Chart Abstraction, or Over-Reading. Selecting the right vendor to partner with
your health plan can make all the difference for having the right people in
place, meeting established deadlines, and generally surviving the season with
no new ulcers.
The most obvious vendors that come to mind are those that actually contract
to perform specific functions related to HEDIS. These vendors may be
specialized in strictly HEDIS collection and data analysis, or they might have
a broader focus that encompasses health care Quality Improvement in general.
These supporting organizations can be an asset for health plans who do not have
the personnel, resources, or expertise to guarantee a successful HEDIS season.
Based on some of the HEDIS experts I have spoken with, many Managed Care
Organizations choose to do either the Abstraction or the Over-Reading
themselves, and will hire a third-party vendor to do the other one. It is
sometimes beneficial for health plans to conduct the Abstraction in-house and
outsource the Over-Reading to vendors. This way they have a fresh or second set
of eyes from outside the health plan doing a review of their work. After all
HEDIS is designed to help improve the whole Quality Management process. Of
course this is not always the case. I am sure there are some who do all aspects
of the work internally, while still others might outsource all possible work to
external vendors.
The other type of vendor I wanted to discuss was the staffing vendor, a
topic near and dear to our hearts. Whatever approach a health plan takes in
performing its HEDIS functions, it does not happen without a fully staffed team. We had previously discussed what
happens when Managed Care Organizations start
hiring late for Overreaders and Abstractors. Solving the staffing issue early can be critical to having a
successful outcome for a health plan’s HEDIS season and scores. When
considering which vendor can provide the best talent, there are many advantages
in utilizing an experienced and specialized staffing firm, such as CareNational.
Some Managed Care Organizations contract with just one staffing vendor for
all their contract needs. This may be convenient in many ways, but it does beg
the question: How specialized is your recruiting vendor? Can they
truly understand the hiring manager’s needs and provide expert talent if they
are simultaneously searching for nursing staff, and clerical staff, and
custodial staff, and security staff, etc? (And those are just the orders they
are working on for your company…) Other companies
combat this by partnering with multiple staffing vendors, but that brings its
own challenges. Larger health plans face a struggle with this as many of them
utilize a vendor management system (VMS) which involves numerous staffing
agencies competing to provide staff. But a system that should force the best
results, instead sees agencies submitting candidates that are often
unqualified, or reflect little to no direct HEDIS experience. Having so many
varied vendors involved in the submission of candidates can potentially lead to
a lot of wasted time and resources for the HR staff and their hiring managers.
The danger is that top talent may be overlooked or not contacted in time,
as they are busy filtering through piles of unqualified candidates from those
vendors not familiar with HEDIS and what skills they should be identifying for
the health plan’s needs.
CareNational specializes in HEDIS support for start-up health plans,
third-party outsourcing companies, established health plans or simply those
plans that are looking to improve their survey scores as well as Medicare Star
ratings. We have experienced professionals on staff who understand the
challenges of the HEDIS workflow and processes. We source candidates nationwide
with HEDIS experience year round so we have the quality and quantity of staff
needed for the most demanding and last-minute staffing requirements.
CareNational is an expert in Quality
Improvement and HEDIS staffing/career search consultation in these
specialized areas, but we do not perform the functions ourselves. So how did we
do? Did you find this information useful? We love feedback!
For more information on HEDIS and to discuss our current opportunities,
reach out to one of CareNational’s best Medical Management recruitment leaders!
Contact us at 1.800.974.4828 x305, or email us at contact@carenational.com.
