Three key strategies for meeting HEDIS/STARS measures and improving performance

El Reda, Dr.PH, MPH, VP, Population Health Strategy and Analytics Practice Services

Meeting quality measures and improving performance don’t just happen on their own but require some effective in-practice strategies. The top three strategies are:

  1. Complete and accurate documentation
  2. Proactive patient outreach
  3. Effective patient engagement

Health plans are constantly developing strategies to improve performance in quality metrics, such as HEDIS and STARS. One growing trend we see is the incorporation of these metrics into value-based contracts where minimum quality performance thresholds must be met to unlock maximum contract incentives. What does this mean? This means that providers in value-based contracts can still leave substantial incentive dollars on the table if they fail to meet performance targets for HEDIS/STARS measures, even if they hit cost and use targets. The inclusion of these quality performance gates in value-based contracts highlights the importance of having an effective set of strategies in place to meet HEDIS/STARS Quality Measures and improve performance.

Complete and accurate documentation

It’s not enough to deliver the service to your patients, claims also need to be submitted with the proper codes to count toward the quality standard. All healthcare services must also be properly documented in a patient’s medical record; mistakes or errors in the medical record may impact reported performance. And, finally, deadlines for services need to be appropriately met to reach metric standards, such as the completion of required immunizations before a child’s second birthday.

Proactive patient outreach

Know your patient panel; have a strategy for identifying which patients you need to reach out to by closely reviewing your “gaps in care” lists or your “last seen” lists.  Successful population health management requires proactive outreach to patients; know who you need to call, when, and why. Use your data to drive your outreach and scheduling efforts. Don’t miss out on meeting common preventive care measures like managing hypertension and cholesterol, calculating adult BMI, and conducting mammograms and pap screenings.

Effective patient engagement

Encourage your payers to provide patient incentives, such as gift cards for receiving recommended care services for services like annual well child visits or recommended diabetes-related screenings. Create and implement a plan for sending reminders to patients who are due or overdue for recommended care. Routinely update patient education materials and patient portal content to keep patients interested in taking care of their health and interacting with you. Patients who have positive experiences with their physicians and office staff are more likely to act on your recommendations.

Medical Advantage has decades of in-practice experience helping individual practices to achieve these goals, which require an optimized combination of workflow enhancements, EHR technology use, and staff training, among other factors. With value-based contracts becoming more prevalent, more complex, and more critical to a practice’s financial health, the implementation of focused strategies to meet and accurately document quality measures is more essential than ever before.