Strategies for Improving HEDIS
Performance:
Best Practice From A Primary Care
Perspective
Alix Bouchette, MD, FAAFP
1
Practice Goal
• To provide the highest quality care in order to
generate optimal health outcomes.
2
Healthcare Effectiveness Data and
Information Set (HEDIS)
• HEDIS is a tool used by more than 90% of
America’s health plans to measure performance
and medical services.
3
Strategies for Improving HEDIS
Performance
• Working with our medical assistants to capture
•
•
and submit the clinical data to the respective
insurance companies through appropriate CPT
and ICD-10 codes.
Encouraging members to get recommended
care.
Improving access to timely, routine care.
4
Methods
• Use and submit all applicable codes when
•
•
•
evaluating patients.
Gap lists from different payers are reviewed on
a regular basis
Prior to the patient’s appointment, goals are
identified and highlighted in front of the
patient’s folder.
We try not to miss an opportunity to close gaps!
5
Medications
• Medications are reviewed at the beginning of
each visit and in patients over 65.
– Recognize and discontinue all potentially harmful
drugs such as those included in the Beers’ list.
– Detect potential drug-drug interactions.
– Identify opportunities to decrease polypharmacy.
6
Immunizations
• Immunization records are also reviewed and age
specific immunizations are recommended such as:
– Influenza vaccine
– TdaP
– Pneumovax
– Prevnar-13
– Zoster vaccine
– HPV and Hepatitis vaccines (when
appropriate)
7
Problem List
• Updated by adding new diagnoses and deleting
obsolete diagnoses.
– EMR - Epic
8
Health Maintenance
Colonoscopy
Mammogram
FOBT (for patients who Pap Smear
decline the
Bone Density
colonoscopy.)
Urine for Microalbumin
Flexible Sigmoidoscopy PSA (optional)
Eye Exam
Foot Exam
9
Risk Assessment
• Once a year a complete risk assessment is conducted
•
for elderly patients.
Including:
– Functional and Physical Impairment assessment
– Advanced planning
– Pain screening
– Cognitive impairment screening
– Mental condition evaluation
– Depression risk factor
– Functional ability
10
Care Measures
• Special attention is paid to specific care
measures such as controlling hypertension,
diabetes, and hyperlipidemia.
11
Roadblocks
• Patients do not remember where and/or when
•
•
•
services were rendered.
Patients cannot afford services (deductible,
copay, etc.)
Inability to obtain timely reports from
specialists.
Inability to read the written report from a
consultant.
12