NORTHERN REGION Presented by:

Introduction to HEDIS 2015

Tegan Spencer Quality Improvement Project Coordinator

Lauri Stevenson, RN Performance Improvement Clinical Specialist

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Why are we here today? HEDIS Overview Regionalized Reporting

Medical Record Collection Process Timeline Resources

HEDIS Overview

What is HEDIS? Healthcare Effectiveness Data Information Set Measures the quality of care provided to our members

Why is it Important? Emphasizes the importance of preventive care and follow-

up visits with primary care and specialist Encourages accountability and opportunities for

improvement in the quality of healthcare Required activity by the State Rates are publicly reported

What are the measures?

Types of HEDIS measures:

Administrative Data collected through claims and/or

encounter services billed

HEDIS measures address:

Musculoskeletal Conditions Medication Management Access/Availability of Care Utilization

Hybrid Data collected from both claims and/or

encounter services billed and supplemented with data collected from the Medical Record Chart

Prevention and Screening Respiratory Conditions Cardiovascular Conditions Diabetes

What are we looking for?

When collecting medical records, our vendor will be looking for specific information to satisfy the measure(s).

Some examples of what they will be collecting are:

History and Physicals Progress notes Lab reports OB flow charts Immunization and Disease Registries BMI/ growth charts

Challenging Measures Administrative Annual Monitoring for members on Persistent Medication Children and Adolescents Access to Primary Care Practitioners 12months – 19 years

Hybrid Immunization Status Comprehensive Diabetes Care Eye Exams Performed

Reflecting on HEDIS Reporting Populations Eastern (Solano, Yolo, Napa Counties) Sonoma Marin Mendocino

New Counties reporting HEDIS 2015; Modoc, Lassen Shasta, Siskiyou, Trinity, Humboldt, Del Norte

Contracted with a new Medical Record Retrieval Vendor

HEDIS Regionalized Reporting

New Regional Reporting Structure

Region Counties

Southeast Napa, Yolo, Solano

Southwest Marin, Sonoma, Mendocino, Lake

Northeast Modoc, Lassen, Shasta, Siskiyou, Trinity

Northwest Humboldt, Del Norte

Questions so far? We’ve gone over: What HEDIS is. What types of measures we report on. What we will be looking for in your records. Examples of challenging measures. Regionalized reporting.

Medical Record Collection Easy as 1 – 2 - 3

Medical record collection can be done 3 ways.

1. Fax or Mail in Records 2. On-site visit to collect records 3. Remote access to your EMR

HEDIS 2015 Timeline

February March April May June July August

Vendor Schedules

medical record collection

Primary Medical Record Collection and Review 2/15/15 – 5/15/15

Medical Record Collection and Review stops

5/15/15

PHC provides vendor with list

of records to collect

Additional data collection to determine county level performance

Secondary Medical Record Collection

HEDIS Results locked in

6/16/2015

HEDIS 2015 performance shared with Provider Network

Medical Record Review Validation Audit

5/19/15-5/29/15

Questions? The HEDIS team is available to answer questions by phone,

fax or email. Our contact information is: Southern Region: (707) 863-4282 Northern Region: (530) 999-6828 Email: HEDISMRA@partnershiphp.org Fax: (707) 863-4314

HEDIS 2015 Medical Record Collection Processes & Vendor Introduction- (Content is the same on both dates) Date: Jan 14, 2015 1:00 PM - 2:00 PM PST & Jan 22, 2015 1:00 PM - 2:00 PM PST

Registration URL:https://attendee.gotowebinar.com/rt/8379442248011970562

HEDIS 2015 Refresher – HEDIS Processes and timeline-(Content is

the same on both dates) Date: Feb 11, 2015 & Feb 17, 2015 1:00 PM - 2:00 PM PST

Registration URL:https://attendee.gotowebinar.com/rt/5085220748799904258

Where can you get more information?

HEDIS Website: http://www.partnershiphp.org/Provider/MC_HEDIS.htm

NCQA website for more details on HEDIS: http://www.ncqa.org/HEDISQualityMeasurement.aspx

Contact us! eMail: HEDISMRA@partnershiphp.org Southern Region Phone: (707) 863-4282 Northern Region Phone: (530) 999-6828