Since data is our primary currency, we don’t believe you can ever have too much information. So here’s the info that you might not have found anywhere else. 

 

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NEWS

HDD Readiness for Continued Analytic Support Through COVID-19

Health Data Decisions is actively monitoring the required business activity modifications that the COVID-19 pandemic is mandating for our clients and stakeholders. While we weather this challenge together with our clients, HDD will continue to provide consultative and analytic support in the remote virtual office and data access environment that has always been our standard operating model. 

At this time, we recognize that our clients will require some creativity to maintain health plan and provider operations. Regular wellness activities and health maintenance are no longer the main priority and many patients are already experiencing overwhelming challenges with accessing care, getting medications and ensuring proper nutrition as groceries are becoming out of stock and more expensive.

It has already become more difficult to treat the conditions which drive HEDIS®, Star Ratings and Risk Adjustment Payments.  HDD expects significant disease progression for pre-diabetes, diabetes, mental health, substance abuse, cardiac and pulmonary conditions regardless of hospital bed shortages. We anticipate decreased member satisfaction and confidence as most non-essential procedures will be postponed for many months, if not an entire year or more. Additional challenges will arise from the anxiety, fear and economic uncertainty that members, caregivers and providers will experience.

In the many communications that have been distributed in the past week, CMS has allowed increased flexibility in the provision of health benefits and invited innovative models via the waiver process to address access to care and care continuity. NCQA is already offering relief and flexibility for HEDIS reporting for health plans and for state Medicaid entities who have P4P programs and will likely soon be announcing additional modifications to HEDIS and CAHPS as they typically follow the lead of CMS in these situations. Some key areas of focus including recommendations are detailed below.

Member Engagement and Communication Strategy

 

Prior year member survey results, such as CAHPS, can be leveraged to stratify membership to prioritize outreach to those members that are most likely to feel disconnected or have challenges accessing care. A combination of outgoing communication and increased capacity on phone and chat lines can help facilitate member’s confidence in their health insurer and providers.

 

Recommendations

  • Dedicate additional resources to the call center

  • Create a dedicated COVID hotline and online chat functionality; members may need the plan’s help to locate healthcare providers with capacity as the pandemic progresses

  • Perform e-mail outreach directing members to health plan and local government resources

  • Identify members that are at high risk for COVID-19 and complications using existing population health and demographic data including SDOH as well as public health surveillance reports.

 

Provider Communications and Supply Logistics

 

The American healthcare system faces unprecedented demand to perform tests, triage patients, and provide treatment for COVID-19, yet there will not be adequate capacity of facilities, clinicians and medical supplies and equipment in the coming months. 

Recommendations

  • Health plans are uniquely placed at the intersection of providers, members and state and federal governments, and should start a centralized task force or project team which can leverage all available resources to support providers and help address demand of various parts of the system and alleviate strain wherever possible.

  • Consider breaking down barriers with competitors to form health care leadership teams within your state or region to address the unprecedented challenges posed by this pandemic

 

Model of Care Changes

 

Flexibility and agile responses to the rapidly changing health care environment in the face of the COVID-19 pandemic should be the focus of the plan at this time.

 

Acute care hospitals have been encouraged to delay non-essential procedures and discharge inpatients to skilled nursing (SNF) as soon as possible, particularly in rural areas (see CMS March 17 call transcript).

Recommendations

  • Engage with CMS and local regulators on any waiver or exception process that will allow the plan to make changes to their care delivery model

  • Expand paid at-home services via vendor or in-house staff for home assessments, labs, clinical visits, CNAs, personal care attendants and other caregivers to reduce the need for members to interact with other patients in a doctor’s office waiting room

  • Focus on continuity of care which is likely to be interrupted; use risk suspecting algorithms to identify and contact members who need maintenance visits rescheduled or transitions to telehealth. Prior utilization patterns can be used to identify members who access a certain mode of care on a recurring basis.

  • Review billing arrangements with SNF and rehab facilities to ensure they are fully populating their claims with all relevant clinical and diagnostic information

 

Telehealth and eVisits

eVisit access has been expanded from members in rural areas to all members. CMS will cover brief visits via telehealth for all beneficiaries even if the eVisit standard isn’t met; these visits are now considered equivalent to in-person visits for Risk Adjustment.

 

Recommendations

  • Ensure that members are aware of this option and the benefits vs. in-office care

  • Help vulnerable members get technology set up in their homes to enable eVisits

  • Outreach to providers performing eVisits to educate them on the use of the G2010 and G2012 billing codes which are accepted in the 2020 EDPS model (but not RAPS)

 

Maintaining Quality of Care

 

As the U.S.’s health care system’s focus turns towards managing the pandemic, chronic and acute episodes will continue to require care. Increasing remote care capability where possible may become vital as hospitals’ and doctors’ capacity becomes overwhelmed by emergency care and maintaining social distance is imperative. Some care will still necessitate in-person encounters, but the health plan can play a vital role in alleviating capacity pressure by enabling as much care-at-a-distance as possible.

Recommendations

  • Support behavioral health providers’ efforts to provide telehealth services

  • Ensure mail-order pharmacy and mail-order DME items such as blood pressure cuffs and glucose test strips are available to as many members as possible and that the process is meeting needs

  • Use telehealth to triage members to the most appropriate mode and level of care and help limit unnecessary procedures or encounters

  • Encourage providers’ use of telehealth for medication maintenance for chronic conditions

  • Utilize prescription claims data to surveil medication refill patterns and proactively identify and address gaps, especially those that typically result in ER visits or hospital stays

  • Evaluate the feasibility of setting up remote care capability such as BP monitoring, glucose monitoring, and screenings such as

  • Double down on hospital readmission prevention efforts, as beds become more scarce

 

Medical Economic Impact

 

COVID-19 will dramatically impact the economics of medical care for several years. Although there are still many unknowns, plans can and should start to model the financial implications of the pandemic and modify these models as more data becomes available.

 

Recommendations

  • Start to modify utilization projections and associated reserves to account for patterns of care changes at various points of the COVID-19 pandemic and associated response

  • Evaluate the impact of macroeconomic changes on the plan’s membership including unemployment, changes in consumer behavior and the impact of social distancing protocols

  • Start developing new benefit and pricing models to adapt to the new economic landscape that the pandemic will drive in the next 6-12 months and beyond

 

The team at Health Data Decisions is committed to effectively using data to facilitate a positive impact on the challenges our friends, clients and partners face during and after this health crisis.  I want to thank my staff for all their hard work, dedication and passion to this cause. We would welcome your feedback. You can contact me directly at Mike@healthdatadecisions.com.

June, 2018

HDD to Deliver Keynote Address at RISE Qualipalooza Leadership Summit

Health Data Decisions’ CEO Michael Blumental will partner with Janine Sala, Associate Director of Clinical Quality at UnitedHealthcare, to deliver the keynote address at RISE Qualipalooza 2018 in Phoenix.  Their presentation will discuss methods for using social determinants of health to predict and influence HEDIS® compliance.

 

Register now and meet us in Phoenix!

January, 2018

HDD to Deliver Innovative and Data-Driven HOS and CAHPS Strategies to Major Regional Health Plan

A major Southern California Medicare Advantage provider has selected Health Data Decisions to help develop an intensive and focused program to improve member satisfaction and Medicare Health Outcome Survey (HOS) results. This program adds to a growing book of business for HDD within California, which now includes health plans in all regions of the state. HDD will use innovative analysis of historical and comparative survey data as a basis for developing collaborative programs between the health plan and its provider network. The CAHPS and HOS survey tools targeting satisfaction and health outcomes are a substantial part of the Medicare Stars program that reports health care quality to Medicare Advantage members and quality bonus payments to health plans.

January, 2018

URAC selects HDD as a Data Validation Auditor for Specialty Pharmacy Accreditation

URAC has selected Health Data Decisions as a Data Validation Auditor for its Pharmacy Accreditation programs. Health Data Decisions brings a solid analytic approach and extensive experience in health care quality and utilization management to these programs.  “We selected HDD because they will provide high quality data validation services to our clients in a collaborative educational process rather than a punitive one,“ said Marybeth Farquhar, PhD, MSN, RN, URAC’s Vice President of Quality, Research, and Measurement. Health Data Decisions will begin Data Validation Audits as of March, 2018.

September, 2017

HDD retained by two consumer driven health plans to support EDGE server submissions.

Accuracy of EDGE data is key to obtaining maximum risk adjustment payments for both Medicare and Marketplace health plans. Health Data Decisions has partnered with two innovative, consumer driven health plans to build data transformation, validation and error resolution processes for EDGE Server submissions. Improved EDGE server submission has resulted in many fold returns on investment for Health Data Decisions clients. 

September, 2017

HDD to host a beginners' “HEDIS® 101” workshop for all RISE HEDIS® Quality Summit Attendees

Please join us on Monday, October 16th at the Hyatt Regency, Miami for the Annual RISE HEDIS® Quality Summit. Keith Bell, MPH, and Michael Blumental of Health Data Decisions will be leading an interactive educational workshop, joined live via videoconference by Janine Sala of United Health Plan Las Vegas’ clinical team. The 3 Part session, free with registration, runs from 9 am to noon prior to the conference kickoff. Covering the basics of HEDIS® as well as some more advanced topics, HDD will use interactive polling, question periods and quiz session to ensure maximum educational value for all participants. If you’re new to HEDIS® or want a refresher, don’t miss this session.

September, 2017

HDD to Provide Keynote Address on HEDIS® 2018 Changes at the RISE HEDIS® Quality Summit October 16th in Miami

Keith Bell, MPH, Director of Quality Improvement and Measurement at HDD will provide an interactive overview of the key changes NCQA has made to HEDIS® 2018 specifications. He will go beyond the summaries provided to discuss the real impact that changes to the measures and the general guidelines may have on your rates and how you manage your review. 

August, 2017

HDD retained for 4th year in a row to support and maintain National Hospital Quality Indicators

Health Data Decisions, in partnership with a lead contractor, has been retained for another year to program, maintain and support a suite of 99 Hospital Quality and Safety Indicators for the federal government.

August, 2017

HDD to Lead Roundtable at RISE West September 18-19 at RISE West

Join us at 4PM September 18th, for a special roundtable discussion on year-round HEDIS®, tracking, trending and measure projections at the Fairmount Scottsdale Princess. Mike Blumental, CEO of Health Data Decisions, will be leading a discussion for all interested conference participants. If you would like further information about this roundtable, contact us at Info@healthdatadecisions.com for an overview and presentation.

July, 2017

HDD HEDIS® Consulting Practice Now Serving Over 6 Million Covered Lives

HDD has been contracted to validate vendor HEDIS® extracts by a large regional health plan, using our proprietary Data Decisions Quality Engine Analysis. HDD’s HEDIS® consulting and analytic solutions now are used across plans covering 6 million enrollees in 15 states.

June, 2017

HDD HEDIS® Clients See Large Improvements in HEDIS® 2017 and Stars Rates

HDD clients had another successful year in 2017. Notable improvements among HDD’s stable of health plan clients include:

  • A Medicare SNP program moved from 3.5 to 4.5 stars

  • A Medicare BCBS plan retained a 4 Star rating while improving across several key measures.

  • A BCBS Marketplace plan that saw its rate jump from 1 Star to 3 Stars in just the second year of its joint program with HDD

  • A mid-size MediCal Plan improved its rates by 13% over the prior year, the largest gain of any of the MediCal plans in HEDIS® 2017.

May, 2017

HDD expands HEDIS® practice into Texas and Nevada. 

Health Data Decisions has been hired by a Medicare Advantage plan to improve its HEDIS® operations and drive quality improvement efforts to achieve 4 Star by CY 2018. Beginning in March 2017, HDD jumped in mid-season to take over chart review operations and oversee HEDIS® production for a plan in its third year of operations. For HEDIS® 2018, HDD will help design, execute and measure data improvement and quality intervention strategies intended to improve the plans overall Star Ratings.

April, 2017

HDD co-develops a new Primary Care Payment Model with FMAHealth

Family Medicine for America’s Health, a coalition of family practice provider organizations, has partnered with HDD to develop an innovative primary care payment model that reduces overall cost while improving quality. The model incorporates socio-economic factors, efficiency and quality metrics, as well as traditional risk and claims costs to estimate a prospective global payment. The methodology was developed based on a comprehensive review of value-based payment models in use for primary care across the U.S.

January, 2017

HDD adds a 3rd MediCal plan to the HEDIS® client list

HDD will help a MediCal plan validate health plan HEDIS® extracts prior to submission to their certified vendor and improve their overall data accuracy using its proprietary Data Decisions Quality Engine.

December, 2016

HDD expands HEDIS® clients to Puerto Rico and Hawaii

Health Data Decisions is pleased to announce its HEDIS® practice has expanded outside the continental US.  In October 2016, HDD started working on HEDIS® consulting, analytics and program oversight roles for one of the largest health plans in Puerto Rico, along with an analytics and data warehouse vendor that provides the majority of healthcare analytics to health plans on the island. In December 2016, HDD was retained by a Medicaid MCO on the Island of Oahu, Hawaii to perform an assessment and analysis of their current HEDIS® operations. 

September, 2016

HDD opens new corporate office outside of Boston

Health Data Decisions has opened new offices in West Bridgewater, Massachusetts. It will operate as a central hub for its East Coast staff and IT and administrative team, improving communication and coordination of staff in five states.

July, 2016

HDD launches monthly HEDIS® webinar series

HDD has launched a HEDIS® Best Practices Webinar series to offer expert information and guidance for clients, prospects and interested parties. After a successful launch attended by over 100 participants from 35 unique health plans, HDD has decided to provide this complementary series on a monthly basis. The interactive webinars are and are provided at 2pm EST, on the third Wednesday of each month.

January, 2016

HDD expands HEDIS® client base to California

HDD has been retained by two separate Medicaid health plans in Northern California to review and improve their HEDIS® operations. HDD will help drive specific rate improvement in key state MediCal measures that drive auto-enrollment and cap payments.

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