identifying barriers to achieving hedis goals peggy ketterer, rn, bsn, chca health services advisory...
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![Page 1: Identifying Barriers to Achieving HEDIS Goals Peggy Ketterer, RN, BSN, CHCA Health Services Advisory Group](https://reader030.vdocuments.us/reader030/viewer/2022032709/56649ecf5503460f94bdcfde/html5/thumbnails/1.jpg)
Identifying Barriers to Achieving HEDIS Goals
Peggy Ketterer, RN, BSN, CHCAHealth Services Advisory Group
![Page 2: Identifying Barriers to Achieving HEDIS Goals Peggy Ketterer, RN, BSN, CHCA Health Services Advisory Group](https://reader030.vdocuments.us/reader030/viewer/2022032709/56649ecf5503460f94bdcfde/html5/thumbnails/2.jpg)
Background
• Plans are required to report a set of HEDIS® measures on an annual basis
• AHCA has identified performance measure targets based on national Medicaid means and percentiles
• Measurement year 2007 was used as a baseline
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA)
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Today’s Session
• Discuss data sources for each measure
• Discuss common data collection issues
• Discuss barriers to improving performance
• Discuss best practices/improvement efforts
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Ground Rules
• Everyone must say something!! I expect each plan to talk about either one challenge or possible intervention.
• If you don’t speak, I’ll call on you!!!
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Lower Performing Measures
• Prenatal Care
• Postpartum Care
• Cervical Cancer Screening
• Dental Visits
• Other measures – based on individual health plan performance
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Prenatal Care
Data sources:
• Eligibility
• Claims/encounters
• Medical records
• If available, other internal databases such as a prenatal care program
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Prenatal Care
Common data collection issues:
• Global billing
• Resource intensive medical record review
• Others?
![Page 9: Identifying Barriers to Achieving HEDIS Goals Peggy Ketterer, RN, BSN, CHCA Health Services Advisory Group](https://reader030.vdocuments.us/reader030/viewer/2022032709/56649ecf5503460f94bdcfde/html5/thumbnails/9.jpg)
Prenatal Care
Barriers to Improving Performance:• Plan doesn’t know about pregnancy early
enough to get the visit performed• Global billing does not typically allow for
capture of individual visit dates• Visits are not in appropriate timeframes• Members are non-compliant• Visit documentation does not contain
necessary components• Other barriers
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Prenatal Care
Best Practices/Improvement Efforts• Open discussion of potential interventions• Best practice resources• Center for Health Care Strategies (CHCS)
Toolkit – Toward Improving Birth Outcomes
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Postpartum Care
Data sources:
• Eligibility
• Claims/encounters
• Medical records
• If available, other internal databases such as a prenatal care program
![Page 12: Identifying Barriers to Achieving HEDIS Goals Peggy Ketterer, RN, BSN, CHCA Health Services Advisory Group](https://reader030.vdocuments.us/reader030/viewer/2022032709/56649ecf5503460f94bdcfde/html5/thumbnails/12.jpg)
Postpartum Care
Common data collection issues:
• Global billing – no incentive for physicians to submit separate bill
• Resource intensive medical record review
• Others?
![Page 13: Identifying Barriers to Achieving HEDIS Goals Peggy Ketterer, RN, BSN, CHCA Health Services Advisory Group](https://reader030.vdocuments.us/reader030/viewer/2022032709/56649ecf5503460f94bdcfde/html5/thumbnails/13.jpg)
Postpartum Care
Barriers to Improving Performance:• Global billing does not typically require
date of service for postpartum care visit• Visits are not in appropriate timeframes• Members are non-compliant• Visit documentation does not contain
necessary components• Other barriers
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Postpartum Care
Best Practices/Improvement Efforts
• Open discussion of potential interventions• Best practice resources
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Cervical Cancer Screening
Data sources:
• Eligibility
• Claims/encounters
• Medical records
• Lab vendors
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Cervical Cancer Screening
Common data collection issues:
• Capitated reimbursement for lab
• Inaccurate coding by providers
• Resource intensive medical record review
• Others?
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Cervical Cancer Screening
Barriers to Improving Performance:
• Members are non-compliant• Other barriers
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Cervical Cancer Screening
Best Practices/Improvement Efforts
• Open discussion of potential interventions• Best practice resources
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Annual Dental Visits
Data sources:
• Eligibility
• Claims/encounters
• Dental vendors
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Annual Dental Visits
Common data collection issues:
• Difficulty obtaining dental visit data from dental care vendors
• Difficulty identifying dental providers/provider type
• Others?
![Page 21: Identifying Barriers to Achieving HEDIS Goals Peggy Ketterer, RN, BSN, CHCA Health Services Advisory Group](https://reader030.vdocuments.us/reader030/viewer/2022032709/56649ecf5503460f94bdcfde/html5/thumbnails/21.jpg)
Annual Dental Visits
Barriers to Improving Performance:• Members are non-compliant• Vendors do not submit complete
encounter data• Direct providers do not submit complete
data• Challenges in securing sufficient dental
provider network• Other barriers
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Annual Dental Visits
Best Practices/Improvement Efforts
• Open discussion of potential interventions• Best practice resources
![Page 23: Identifying Barriers to Achieving HEDIS Goals Peggy Ketterer, RN, BSN, CHCA Health Services Advisory Group](https://reader030.vdocuments.us/reader030/viewer/2022032709/56649ecf5503460f94bdcfde/html5/thumbnails/23.jpg)
Other Measures
• Challenges• Interventions/Improvement Efforts
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Handouts
• Best Practices Resource List• CHCS Toolkit – Toward Improving Birth
Outcomes• California Health Care Foundation -
Improving Access to Dental Care in Medicaid
• CDC – Guide to Community Preventive Services
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THANK YOU FOR YOUR PARTICIPATION!