Journey up the HEDIS Mountain

Written by Prashant Patel, Associate Regional Director.
Contact him at 1.800.974.4828 x106 or

With the H.E.D.I.S. (Healthcare Effectiveness Data and Information Set) work in the mix, CareNational has been on a quest to find qualified nurses and clerical support staff to fill assignments for our clients related to this critically important Quality Improvement survey. 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 a highly-qualified leader in healthcare thought about her outlook on HEDIS. Nancy Rudner, DrPH, RN is the Owner, Healthcare Consultant, and Nurse Coach at Health Action. A family nurse practitioner with a doctorate in public health and health policy, Dr. Nancy has developed a wide range of interventions to assist patients, communities and workplaces to improve their health and their interaction with health care. Her work has included developing an employee wellness center, university teaching, patient care, and health program evaluations. She made an interesting comparison between the annual HEDIS audit and climbing to the top of a mountain that we wanted to explore in more detail.

HEDIS really is like scaling a huge mountain – you need specialized tools, guides, and a plan for each step in order to successfully navigate your way through this yearly audit!

Although the HEDIS audit does take place every year, all the moving pieces, process changes from last year, and coordination from many departments makes it a daunting task time and time again. From changes in Medicare guidelines, to gradual changes to EMRs (Electronic Medical Records) functionality, to the adoption and implementation of 1CD-10 coding, it is virtually guaranteed no two HEDIS audits will ever be the same. Each year, many teams from multiple parts of a health plan collaborate with one another to make sure that data set is validated, charts are abstracted, data is collated, and quality checks are done by over-readers. There is a complex and multiple step process that needs to be followed in order to make sure that this audit is preformed effectively and efficiently.

Now back to the mountain, we asked our expert to act as our Sherpa (guide) for tips on how to traverse this audit without losing your footing. Dr.Nancy Rudner pointed out that while navigating this mountain you must put “markers along the way to measure progress not only helps the team leads, but also helps each member of the team feel the momentum.” If everybody knows how far the whole team is through this process, it builds confidence and makes it seem like this mountain (audit) is an attainable goal even to the lowest ranking individual on the team. “Celebrating progress weekly can be like having a treasure map. Some indicators you can track are the percent of providers contacted, the percent of records retrieved, the percent of each measure sample that is completed or closed.” Without acknowledging and enjoying these small victories, it can make a walk up the hill seem like ascending Everest. Instead you must celebrate little successes in order to keep everyone moving and to create a clear picture of what needs to happen to get to the top!

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 that understand that 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 specializes 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!

Written by Prashant Patel, Associate Regional Director. For more information on HEDIS and to discuss our current opportunities, reach out to one of CareNational’s best Medical Management Recruiters! Contact him at 1.800.974.4828 x106, or email him at