Understanding HEDIS: Why It Matters for Your Practice

What is HEDIS?

HEDIS is a standardized performance measure set by the National Committee for Quality Assurance (NCQA). These measures evaluate the effectiveness of care and services provided by healthcare organizations, particularly health plans. 

With over 90 different measures across six domains of care, HEDIS allows for a comprehensive assessment of healthcare quality. These domains include:

• Effectiveness of Care
• Availability/Access of Care
• Experience of Care
• Utilization and Risk Adjusted Utilization
• Health Plan Descriptive Information
• Measures Collected Using Electronic Clinical Data Systems

By gathering and analyzing data across these domains, HEDIS provides a detailed picture of how well a healthcare organization performs.

The Centers for Medicare and Medicaid Services (CMS) requires the NCQA to implement a scoring system to determine how well health plans and healthcare providers deliver care, with a rating scale of one to five (one being poor and five being excellent). 

The HEDIS scores are evaluated using evidence-based criteria, focusing on preventive and clinical care. After the assessment, CMS provides performance incentives to all participating organizations that meet the standards of care. 

Knowing how to improve HEDIS scores is crucial for enhancing the quality of healthcare delivery. A low HEDIS rating can be viewed as your practice’s inability to provide adequate care to your patients, which could negatively impact your reputation. 

Government agencies and employers also use HEDIS data to assess the effectiveness of an organization’s care delivery and healthcare plans, helping patients know which practice is more reliable and effective as their care provider.

Why HEDIS Matters to Your Practice

Here are some reasons why HEDIS is a critical component of running a successful practice, including the ways it impacts your practice management:

Quality Improvement

Regularly reviewing your organization’s HEDIS scores can help you pinpoint areas that need improvement, ultimately leading to better patient outcomes. Using Meditab’s easy-to-use and customizable HEDIS-equipped EHR software will surely put your organization at the top of the game.

Increased Reimbursements

Insurance companies, such as Medicaid and Medicare, base reimbursements on HEDIS performance. Practices with high HEDIS quality scores can benefit from higher reimbursements, while those with lower scores may face penalties. To ensure that your practice maintains high HEDIS scores, utilizing a software system like IMS can help streamline your workflows and billing processes according to HEDIS regulations.

Regulatory Compliance

Complying with HEDIS measures ensures that your practice meets various regulatory requirements. Non-compliance can result in loss of accreditation, sanctions, or exclusion from provider networks, all of which can affect your practice’s reputation. Meditab’s QRA HEDIS services empower practices to give their undivided attention to their patients without having to worry about fulfilling their compliance requirements.

Data-Driven Decision Making

HEDIS provides a wealth of data helpful in making informed decisions about your practice’s operations. This data is invaluable for strategic planning, providing a bird’s-eye view of trends in patient care and helping you understand the effectiveness of different treatment protocols.

Competitive Advantage

High HEDIS scores can help attract more patients seeking top-tier care.

Managing and submitting HEDIS information annually can be challenging for some providers. With all the administrative burdens that come with compliance requirements, you need a dedicated tool and a team of support experts to take those heavy loads off of your shoulders. Fortunately, Meditab can provide you with both!

Meditab’s flagship product, Intelligent Medical Software (IMS), is an all-in-one, fully customizable practice management and billing software solution with integrated HEDIS reporting features. We’ve designed IMS to streamline your organization’s workflow and generate accurate reports for better compliance. 

Along with an excellent EMR platform, our Quality and Risk Adjustment (QRA) team has your back, providing you with all the tools and assistance you need with every HEDIS measure. They can help identify the measures you need to work on, ensure that claims are coded accurately, provide regular HEDIS star reports, and more. 

We believe that increasing HEDIS scores requires intelligent solutions and continuous support. If you need help improving your HEDIS compliance and ratings, learn about IMS today and discover how our QRA team can make everything easier for your practice.

Learn About Our HEDIS Reporting Tool