HEDIS score reporting are often required in public markets as well, where the results are often reported to the states, or occasionally counties, in which the plans reside. Pharmacy measures focus on medication management of acute and chronic physical and mental illness, appropriate medications in the elderly, and management of polypharmacy. Specialty measures are directed toward inappropriate imaging.
Aside from being a collection and reporting contract requirement for many of our customers and our own health plan, HEDIS gives Magellan valuable information about the populations we serve.
By following the behavioral health data, we collect, for example, we can identify gaps in network performance in patient follow-up patterns, management of drug and alcohol abuse, and prescribing and adherence to medications. This allows us to design and implement interventions that can improve outcomes and reduce cost of care. Analysis of HEDIS data helps identify gaps in care, particularly preventive care, in such important and chronic populations as patients with diabetes mellitus, patients with cardiovascular disease, and patients with lung disease.
We can also identify and address at-risk pediatric populations who fail to complete preventive care such as immunizations, dental and well-child care. As the healthcare industry moves more and more toward value-based purchasing, all providers, insurers and their vendors are necessarily increasingly focused on the quality of care that is delivered.
The impact of this should be better outcomes for our members. Any tips, comments, ideas would be welcomed. Your email address will not be published. Save my name, email, and website in this browser for the next time I comment. Data is reported individually for each product and line of business Measure data is collected is a variety of ways. Tags: Behavioral Health , data , Dr.
Janet Maurer. Most providers choose healthcare to serve their patients, not specific standards. But a lack of awareness and not instituting efforts to meet quality and preventative care requirements can negatively impact HEDIS scores. As HEDIS rates increase, there may be a potential for the provider to earn additional revenue through pay-for-performance models. One common problem that impacts HEDIS scores is a lack of, or inaccurate, claim coding and documentation.
The utilization of electronic healthcare records EHR can assist in reducing obstacles for maintaining accurate information by providing reminders for patient care needs, encouraging adherence to standardized templates, and by having documentation follow the care of the patient. As healthcare continues to move toward more value-based care , the focus remains on the quality of healthcare delivered and working toward better patient outcomes.
HEDIS provides consumers with the ability to compare health plans to ensure that the one they choose will provide optimal care for their healthcare needs. Maureen Bonatch MSN, RN is a freelance healthcare writer specializing in leadership, careers, and mental health and wellness. She is also a fiction author. She is the owner of CharmedType. Goals, Benefits, Improvements. Curious if you have the right staff in the right roles?
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