Preparing for HEDIS 2019: How to Communicate with Providers

Beth Hickerson, Healthcare Transformation Consultant Health Plan Solutions, Uncategorized

Preparing for HEDIS 2019: How to Communicate with Providers

As we near the end of the HEDIS measurement year, health plans and providers are busy making their final efforts to close gaps-in-care. This time of year can be incredibly stressful for providers, who are being asked to squeeze in as many visits and services as possible before the end of the year. Health plans are also receiving their first look at the HEDIS 2019 technical specifications, including a number of new measures. There is a lot to take in this year, with several new measures being added to an already unwieldy list of HEDIS measures.

As you prepare to engage with providers regarding the HEDIS 2019 changes, there are a few things you might want to consider before sending out the next blast email or provider newsletter. If you want to succeed in working with practices, you first need to understand where they are coming from.

Practices serve the patients, not the standards.

While they recognize the importance of clinical best practices, providers are focused on caring for patients and ensuring that they offer recommendations that are best for each individual. All of the documentation that is needed for HEDIS and other clinical measures can sometimes feel like a bunch of extra work that does not serve the ultimate goal of providing patient care.

Extra reimbursement gets the practice’s attention.

If health plans are asking providers to do extra work to track a new measure or collect specific data, it is only fair to pay them for their time. When you think about it, providers are not any different than health plans in that sense. Health plans focus their attention on the measures that will earn them higher quality ratings and bonus payments from Medicare, Medicaid and commercial customers. Likewise, providers will direct their limited resources toward the measures that earn the highest reimbursement.

Consistency among measures promotes compliance.

Practices are more likely to follow clinical measures when they make sense for the majority of patients. When payers align their measures, it creates a common standard for providers. For example, NCQA changed the standard for Controlling High Blood Pressure to <140/90 mm Hg across all of the population groups for HEDIS 2019. This is consistent with the Medicare MIPS measure for Controlling High Blood Pressure, which is also <140/90 mm Hg. Many practices are using Controlling High Blood Pressure as their required MIPS outcomes measure because it is easy to capture. This will no doubt have a positive impact on the health plan’s HEDIS 2019 results.

EHR vendors are driving the changes.

While health plans are looking to providers to implement the changes for HEDIS 2019, the practices are looking even further downstream to their EHR vendors. It can take months for EHR vendors to get their systems up-to-date to reflect the latest HEDIS 2019 specifications. Providers are not able to start modifying workflows or reporting data until their EHR vendor completes the update. Health plans need to be aware of these constraints and set realistic timelines when communicating with providers.

Practices can’t always plan for what’s ahead.

It has been said many times, but it is still true. Practices are focused on what they need to do today, not next year. As much as they would like to be able to plan ahead for HEDIS 2019, they don’t always have the resources to do so. Even if health plans provide a heads-up on the proposed new measures, practices will not likely change their behavior until it is necessary. This also ties back to their dependence on EHR vendors to update their systems before they can make any changes.

Practices appreciate a real-world perspective.

While there are many advanced technologies available, they don’t reflect the experience of most practices. It is important to acknowledge the reality providers live in when communicating about HEDIS 2019 or other programs. Writing a big splashy article about how NCQA will now accept blood pressure data transmitted electronically from a patient’s remote monitoring device won’t make sense if only a small percentage of practices are using that technology.

Data drives change in practices.

Providers always appreciate when data is used to make a point. It can help show the impact of a change in workflow or clinical practice. Often, health plans write articles with generic statements about improving quality and reducing cost. But how will the change improve quality? How much will it save in the next year, or five years? The more health plans can share actual projections, the more they can grab the attention of practices and inspire them to make the changes.

The measurement year for HEDIS 2018 is almost over. With only a few months left to provide services, the main way that health plans and providers can impact the measures is through data collection. Many people think that Medical Advantage Group’s practice consultants go in to practices and change their clinical protocols, but that is rarely the case. If a practice is scoring poorly on a measure, it is almost always because they are not documenting it the way they are supposed to, or the EHR system is not properly capturing or reporting the data.

Medical Advantage Group has an active consulting practice. We work with physician offices to optimize their EHR use and maximize performance on the practice’s selected clinical measures. Health plans can leverage our existing relationship with practices, which in many cases includes boots on the ground working in the provider offices. We can help connect the dots and make sure health plans get the data they need for HEDIS 2019.


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