HEDIS® data collection is usually retrospective; however health plans must show improvement in the quality of care before the current measurement year (MY) is complete.
This last month isn’t just for passive planning periods for the Stars measurement for 2024. Instead, it represents an underutilized opportunity to keep pushing improvements in quality and experiences that could lead to higher Stars performance by the time 2025 rolls around, as well as preparing for success for MY 2026.
Focus on Simple Strategies to Impact Your Members for Success
Now is the time to collect important data and make significant progress on an important set of HEDIS measures, including measures such as:
- Controlling Blood Pressure (CBP)
- Glycemic Status Assessment for Patients with Diabetes (GSD)
- Breast Cancer Screening (BCS)
- Colorectal Cancer Screening (COL-E)
- Social Needs Screening (SNS-E)
Here is a practical example on how to close the CBP measure this month. Since we are getting towards the end of the year, anyone in the office can actually call the patient and obtain their blood pressure reading from their digital device. Make sure that the measurement is actually documented in the EMR. Make it like a nurse note. Make sure the provider looks at the measurement and signs off on it. You should be able to use that as supplemental data. You can also submit those CPT 2 codes for that date of that blood pressure measurement.
It pays to make a special effort around these metrics. Because they are set to be the highest-weighted group of Stars measures (now that CMS has reduced the weighting of the CAHPS measures from 4x to 2x). For example CBM and GSD are now weighted 3x what they were before.
HEDIS measure performance may be the key differentiator that helps plans increase their Star Rating and access the financial incentives that come with 4.0+ Stars.
For example, plans that improve from 3.0 Stars to 4.0 Stars can expect to increase plan revenues between 13.4–17.6% through Quality Bonus Program (QBP) incentives and increased enrollment revenue. A one-star bump is correlated with an 8–12% increase in enrollment, which could make all the difference for long-term sustainability in an increasingly crowded and highly competitive marketplace.
Finally take the time to evaluate your current partners who can help for MY2026
Changes are coming to HEDIS measurements for next year and having a partner that understands how to close gaps will be critical.
When one national MA plan partnered with SynsorMed and it’s RCaaS™ program they were able to get Blood Pressure Control for a high-risk cohort to meet the 140/90 requirement for 79% of the 2000 patients enrolled in the program.
SynsorMed’s multi-channel outreach leveraged a combination of advanced AI, personalized communication and culturally relevant outreach to reach more than 92% of these individuals in just a few months.
As the end of the year approaches, it’s not too late for MA plans to harness what’s left of 2024 to close midyear performance gaps and elevate their Star Ratings. A focused push in December particularly around CMS HEDIS data capture can significantly boost a plan’s overall Star Rating, as well as access to QBP incentives.
Partnering with an experienced healthcare technology partner that offers advanced AI alongside personalized outreach can ensure meaningful connections with members, ultimately driving success.
Don’t wait—take action now to secure a strong finish in 2024 and set the stage for an even more successful 2025.
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To learn more about SynsorMed’s leading-edge Remote Care As A Service Platform and our deep experience in member outreach that will help your plan finish 2024 on a high note.
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