June 3rd, 2017
The 2017 HEDIS season is almost over! But wait, that means it is time to evaluate and start thinking about the 2018 HEDIS season. I know that is probably the last thing Quality Improvement professionals want to hear when they can finally see the light at the end of that long, dark tunnel. The NCQA (National Committee for Quality Assurance) has a published timeline for H.E.D.I.S. (Healthcare Effectiveness Data and Information Set)benchmarks. The deadline for Health Plans to submit their FINAL commercial, marketplace, Medicare, and Medicaid HEDIS (non – survey data) results is Thursday, June 15th by 11:59 PM EST. Certainly, a celebration of some sort is in order after the many long hard months of HEDIS Data Validation, Chart Abstraction and then Over-Reading. However, before you do a brain-purge and lock away all your files until October or November, it is time to assess how things just went.
For CareNational, as one of the nation’s top HEDIS staffing agencies, our perspective is mostly related to the hiring and staffing of HEDIS workers. So we wanted to share some of the success stories that we have heard from our candidates and clients. We also wanted to provide some items for your consideration when evaluating this past season, reviewing what went well and what can be improved upon for the next HEDIS season. Finally we are also providing a handy checklist you can use this fall when deciding which HEDIS staffing agency will make the best partner for your organizations’ needs.
From a staffing standpoint, this season has been a great success for CareNational, and our partnered clients. We were able to provide more than 70 HEDIS professionals to health plans and related production vendors, with an average turn-around of 48 hours from client requisition to our 1st candidate submittal! These positions included a wide variety of HEDIS-focused roles, including an RN Director of Quality Improvement, several Program Managers and Project Managers, non-clinical professional coders, supporting technicians for document scanning and appointment scheduling, and of course the many, many nurses (RNs and LPNs/LVNs) who performed the bulk of Chart Abstraction and Over-Reading.
Without detracting from the contributions and hard work of ALL these HEDIS pros, I have to highlight the achievements of one particular candidate, and what she did for one of our health plan clients. This client is a small-to-medium size health plan that is growing at a pretty steady rate, but has struggled in the past with some of their quality ratings. They knew fully well that having a better HEDIS program would not only improve their financial reimbursements, but related quality scores would also drive consumer decision-making regarding which health plan to purchase. When they asked us to find an expert to serve as Program Manager and turn around their Quality Management and HEDIS programs, we knew just the right person. Fast forward 10 months, and thanks to her efforts, that Managed Care Organization moved their Medicare Star rating from 2 to 3.5 Stars! Like any good health plan they will continue their efforts to improve those quality ratings, but that is a tremendous achievement in such a brief amount of time.
So how do you think your organization did with preparing for the 2016 HEDIS season? Did you find the right expert to spearhead your program? Was your hiring process on track with the HEDIS timeline in order to achieve your goals? Were you able to effectively determine the correct size and scope of your HEDIS staff prior to beginning the hiring process? How did you attract the best HEDIS workers to your team, as opposed to your competitors? Did your organization use any vendors for HEDIS production or staffing? If you did partner with a staffing agency, was it in time to support your hiring needs, or do you feel you started the hiring process a little late? Did you outsource all (or some) of the HEDIS process, and are you considering bringing that capability back in-house? If you had to do it all over again (and you will) what would you do differently?
Of course, in terms of actual quality metrics, the preliminary and official scores will not be released for a few more months, but we wanted to get the discussion about staffing started early, while it is still fresh in everyone’s minds. We hope that the checklist available above will be useful when you evaluate this season, and when you consider what staffing vendor to partner with for the 2018 HEDIS hiring season.