HEDIS® 2018 is Coming: Is Your Team Ready for Medical Record Retrieval, Review and Abstraction?

By Melanie Richey

What measures will you abstract in 2018?

Is your abstraction staff in place?

Have you secured your auditor?

Is this your first NCQA HEDIS1 Season?

Is your NCQA-certified HEDIS software vendor in place? 

Wherever you are in the process of preparing for HEDIS 2018, Centauri Health Solutions® will guide you through each step needed to meet important milestones during the 2018 season.

Step 1: HEDIS Medical Record Retrieval, Review and Abstraction

Timeline: Start now and continue this step throughout November

Determine your staffing requirements and your budget to meet those requirements

  • Did your secure and review enough records to meet your goal rates in 2017?

Determine whether your internal team can perform the work, if you need to hire an external vendor, or both

  • How many people will you need on your team?
  • Do you need to ramp up resources with existing permanent positions, or will you hire temporary resources?

Retrieval and Abstraction Teams

  • Determine whether you need to have separate retrieval and abstraction teams.
  • Update position descriptions, capture the skills and requirements necessary to ensure HEDIS success.
  • To save on internal resources, consider outsourcing retrieval and/or abstraction by hiring qualified, experienced seasonal staff.

Hire!

  • On or before November 15, align with the most capable, experienced HEDIS reviewers and abstractors.
  • On or before November 22 (the day before Thanksgiving), secure commitments from qualified candidates.

Step 2: Training

Timeline: October 2017 – January 2018

  • Do you have an archived Q&A from the 2017 HEDIS season?
  • Review those archived FAQs to identify any topic or measure that solicited questions or confusion during the last season. Ensure that they are covered in depth, within your training materials.

Do you have Subject Matter Experts (SMEs) for each of the measures or functional areas?

  • Engage your SMEs in the creation and revision of your presentations.
  • Highlight your SMEs’ best practices within your slide decks.

Was your Inter-Rater Reliability (IRR) Testing effective last season?

  • Did your auditor raise questions regarding validity?
  • Did you find that some abstractors “slipped through the cracks” and made annotation and/or data entry errors, either because they were not properly trained or did not have the background to accurately find data points?
  • Take the time to address the above concerns in this season’s training.

Ensure that there is a comprehensive understanding of NCQA’s 2018 Technical Specifications across all functional areas.

  • Engage your auditor in this process where necessary.

Create the training schedule

  • Early to mid-January is optimal to begin training, so that it’s fresh in everyone’s minds AND to minimize training staff, who may take other positions prior to the start of the HEDIS season.
  • Schedule training. Now that you have determined your timeframe for training, you can hire candidates with a firm start date.

Teamwork is essential to HEDIS success! Cross-functional training ensures that all teams have insight into what their HEDIS cohorts are doing.

  • Include all teams involved with HEDIS in your training:
    • The reporting team can learn why they are programming reports a certain way.
    • The medical record abstraction team can learn how the data input affects reporting.
    • The software technicians can learn where data comes from.
    • The retrieval team can learn what happens to the records they bring in.

Step 3: Reporting

Timeline: February 2018 – May 2018

Were you able to accurately track and trend abstractor IRR and overread scores last season?

  • Did you have multi-level reporting to meet your reporting needs and help you successfully manage your project?
  • Did your Executive Dashboard reports provide the high-level view that is necessary for oversight of HEDIS Quality operations?
  • Did your reports contain the data elements and information to provide a high-level view of the project for the executive team as well as support ongoing operations?

Has your report assessment found that last season’s reports need a tune-up?

  • Review last year’s “nice to have” reports:
    • Can you justify those reports, now that you have done an assessment of how they can yield the data necessary for the ongoing success of your project?
    • Will those new reports lessen the manual work and make your job easier?
  • Now is the time to adjust your reports. Get your requests in early: Data teams usually have a full task list, so make sure you are at the head of the line for custom reports.

Step 4: Breathe

Consider Centauri Ascent®, our suite of cloud-based, real-time reporting and  management tools.

As for those who have been through this before, remember that this is a new HEDIS Season!

  • Build on the knowledge that you gained last season
  • Learn from things that didn’t work
  • Employ the best practices of what did work
  • Call us to help build a successful HEDIS 2018 program

Learn more about our HEDIS Solution

https://www.centaurihs.com/resources/content-library/insights-hedis-solution

Contact us today. Learn how Centauri Health Solutions’ consultative advisory approach to HEDIS can assist your organization.
888.447.8908 • info@centaurihs.com • www.centaurihs.com

[1] National Committee for Quality Assurance (NCQA®); Healthcare Effectiveness Data and Information Set (HEDIS®)