Is your health plan ready for HEDIS Medical Record Review season?

Challenge

The client was forecasting a poor Star Rating heading into their upcoming HEDIS/Hybrid season with several measure rates decreasing and year over year challenges with chart retrieval. In the past, the HEDIS team lacked the necessary focus and rigor on the Medicare Stars measures.

The client needed immediate support in building foundational governance, increased data analytics forecasting support and strategies for robust chart retrieval workflows.

Solution

Over a five-month partnership, ProspHire conducted a thorough, current-state assessment of the client’s HEDIS/Hybrid Medical Record Review strategies. The engagement included enhancements to the project/execution plan and review of current state reporting requirements.

In doing so, a defined governance and reporting structure was established that created clear transparency and accountability to leadership on project status, risks/issues escalation and measure level performance. The team provided real-time analytics support that enabled greater insight into chart status and greater provider outreach capabilities. The engagement team executed best-practice HEDIS/Hybrid Medical Record Review strategies that were utilized to set the foundation for future success.

Result

ProspHire provided additional analytics support through a data-driven approach to provider outreach and medical record retrieval throughout the season. The client increased their chart retrieval completion rate by over 15 percentage points in one year and improved Star ratings in key priority measures. The team was able to improve communication with providers, which led to increased EMR Access. Our best-practice HEDIS/Hybrid Medical Record Review strategies are built to enable improvements in performance for chart retrieval rates within Hybrid season.

For more information on how you can partner with ProspHire to plan for HEDIS Medical Record Review season, fill out the form on the right.