As one of the nation’s best HEDIS staffing agencies, CareNational is always committed to providing the best service possible to our candidates and our clients. This includes continuing education through interactive conversations with contacts from both the client and candidate perspective. As the 2015 H.E.D.I.S. (Healthcare Effectiveness Data and Information Set) season approaches, CareNational is dedicating a series of blogs to help health plans. Since we are experts in providing top-tier talent, but not in actually doing Quality Improvement or HEDIS functions, we are tapping into the extensive knowledge of our candidates using an ‘Ask the Expert’ format.
We recently spoke with La’ Chanda Plummer, a highly qualified and experienced HEDIS Program Manager and Quality Improvement leader that we recently placed at a medium-sized health plan in the Pacific Northwest. It is her job to see that this growing plan achieves NCQA accreditation and completes a successful HEDIS audit. In a previous segment, she explained the process for Data Validation through compliance audits. Here, she explains some of the key benchmarks in the timeline moving towards the heart of the HEDIS season, and how that might impact the hiring process.
As HEDIS staffing experts we know that during this annual need for HEDIS workers, such as Chart Abstractors and Over-Readers, the bulk of the actual work begins after the New Year, often in early February. Yet as we discussed in our last blog, every health plan knows that HEDIS is coming, and the general staffing size and scope can be estimated in advance. In our consultative role, we begin reaching out to Managed Care Organizations in late September and early October, so when they are beginning to plan they know we are here and ready to be a partner on their rapidly approaching HEDIS staffing needs.
Despite our early outreach, many companies are simply not ready to consider spring staffing needs in the fall. Instead, they tend to contact us in mid-January (or later) to begin the HEDIS hiring process. Fortunately, we deliberately develop a robust talent pool of experienced HEDIS workers year round, so we have been able to successfully provide this last-minute support. In fact we once produced and placed 15 HEDIS workers in just 3 days in order to help our partnered health plan meet their staffing need and avoid the risk of losing their HEDIS accreditation from NCQA. This type of 11th hour staffing comes with considerable challenges for both us and the health plan. The most significant of these being that the majority of experienced HEDIS staff have already been contracted with health plans and 3rd party vendors, even if the actual work has not yet begun. So we asked Ms. Plummer why so many Managed Care Organizations wait until February to begin looking for workers.
She explained to us that the pre-HEDIS planning process has multiple milestones. In November or early December the health plan begins to coordinate dates with the data auditors, often 3rd part vendors, to schedule a compliance audit. Not long after, around December 21st or so, the “HEDIS Road Map” is due, which outlines the processes that will be used in the upcoming HEDIS season. Then, towards the end of that month, the auditing team will request a small sample of the data being used, so that they can validate it and ensure it is error-free. It can potentially take a week or longer to validate the data (particularly if errors are discovered and samples need to be re-pulled 4 or 5 times) but shortly into the New Year the health plan will get word the data reviewed is acceptable. That will trigger a request for the larger randomly selected data sample of health plan members. This is the actual data set that will be used for 3 quality functions, 2 of which are consumer surveys sent out by other vendors that affect the health plan’s CMS Star Rating. Those surveys are the CAHPS (Consumer Assessment of Healthcare Providers and Systems) and the HOS (Health Outcomes Survey). The 3rd use of that member data set is the actual MRR (Medical Record Review) which is most commonly associated with traditional HEDIS work (Chart Abstracting and Over-Reading). So it is often not until the 1st of February or so that actual physical or electronic medical records are collected and readied for Chart Abstraction and later Over-Reading. The bottom line is that without adequate preparation and forecasting, those earlier deadlines begin to loom large, thus taking priority away from securing staff in time for a February workload.
As stated initially, CareNational specializes in HEDIS staffing and 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!
Special thanks to La’ Chanda Plummer for providing all this great, detailed information. She is a highly credentialed healthcare industry professional with demonstrated success in leading quality analysis, project oversight and compliance management for high profile employers in the clinical and insurance sector. She is an expert in all things related to Quality Management, NCQA, and HEDIS.
If you would like to speak with Ms. Plummer about HEDIS timelines, or Quality Management processes in general, reach out to Aaron Lebovitz, our Vice President of Client Development and her dedicated consultant partner here. Contact him at 1.800.974.4828 ext 102, or email him at email@example.com