Industry Voices—While HEDIS hibernates, get ahead of the data-reporting curve

Many payers likely breathed a sigh of relief earlier this year when the federal government announced that it was suspending data collection and reporting requirements for a number of high-profile quality-measurement programs.

Due to the COVID-19 pandemic, the Centers for Medicare and Medicaid Services declared in April that it would halt data collection for programs such as the Qualified Health Plan Enrollee Survey, Quality Improvement Strategy, and Healthcare Effectiveness Data and Information Set (HEDIS).

HEDIS is a comprehensive set of standardized performance measures intended to give health insurance buyers the information they need to make reliable comparisons between competing health plans. HEDIS measures include data points such as rates of colorectal cancer screenings, use of high-risk medications in the elderly and follow-up after hospitalization for mental illness.

Qualified health plans are typically expected to report data for HEDIS to CMS between May and June. However, because many HEDIS measures require health plans to perform reviews of patients’ medical records or to obtain information directly from physician offices, CMS officials decided that reporting data for the 2020 plan year would divert resources from the fight against COVID-19.

Though health plans have been given a temporary reprieve from HEDIS, it’s likely that reporting requirements will resume as usual next year. Thus, CMS has encouraged health insurers to continue capturing important data to drive their own quality-improvement programs.

That means health insurers should use this temporary reprieve to get their HEDIS reporting in order. A significant component of that effort involves ensuring that clinical data can be captured more efficiently through digital charts and is of high-enough quality to reflect the care that members truly received.

What COVID-19 has taught us about data quality

In many regards, the state of clinical data in the healthcare industry is not pretty. Often, clinical data is not structured or codified and appears as an ugly blob of text in patient records. For example, measures such as blood pressure or a diabetic’s HbA1c levels are sometimes recorded in the unstructured “notes” fields of electronic health records (EHRs).

Further, if there is a silver lining from the COVID-19 pandemic, it is the critical importance of obtaining accurate data to inform policy decisions that could affect a broader population. In public health crises, accurate data represents a key element necessary to craft responses, allocate resources, measure the effectiveness of interventions, and direct the reopening of local economies. Now, with flu season upon us, the need to base public health decisions on accurate, reliable data will only accelerate.

Following are four reasons why payers should take advantage of the temporary HEDIS reprieve to get ahead of the data-quality curve.

HEDIS may have hibernated during 2020, but payers can’t afford to sleep on data-quality issues that could hinder their quality metrics in 2021. Payers must take advantage of the pause now to implement the processes that yield clean, concise and accurate clinical data.

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