Frequently Asked Questions

How Do We Increase HEDIS Rates?

There are several ways in increase HEDIS rates. These include:

  1. It is important to provide accurate and thorough documentation. Ensure that all services provided to a patient are documented in their medical records. It is also important to double check these medical records to ensure that there are no mistakes or omissions.
  2. Meeting deadlines for services is also important to raise HEDIS rates. This also includes preventative care and other follow up measures and services.
  3. Shifting focus to preventative screenings and providing superior patient care is also important for increasing HEIDS rates. One way to do this is by looking for gaps in well-visits, especially for individuals that are considered high-risk. You should also ensure availability of services by addressing any issues that arise in regards to scheduling appointments.
  4. Including population health management and patient engagement into you plan is also essential for boosting your HEDIS scores. Payers benefit from offering support to provider networks. Direct outreach to engage patients is also encouraged. 
What are EQRO Quality Measures?

EQR stands for External Quality Review, and an EQRO is an External Quality Review Organization. An EQR is the analysis and evaluation of a managed care organization (MCO) that is conducted by an EQRO. These reviews examine different quality measures, including quality of care, timeliness, and access to health care services that an MCO or contractor offers to Medicaid patients.

How many HEDIS measures are there?

The Healthcare Effectiveness and Data Information Set (HEDIS) includes over 90 measures. These measures are updated every year, but in 2019, there are currently 98 HEDIS measures.

The measures are spread across six different domains of care, including Effectiveness of Care, Experience of Care, Utilization and Risk Adjusted Utilization, Access/Availability of Care, Health Plan Descriptive Information, and Measures Collected Using Electronic Clinical Data Systems.

What Are the 6 Domains of Care for HEDIS

There are six domains of care that encompass HEDIS quality measures. They are:

  • Effectiveness of Care
  • Experience of Care
  • Access/Availability of Care
  • Health Plan Descriptive Information
  • Utilization and Risk-Adjusted Utilization
  • Measures Collected Using Electronic Clinical Data Systems.
What are HEDIS star measures?

Stemming from the HEDIS measures, the Centers for Medicare and Medicaid Services (CMS), created a star rating system. This system rates how a health plan’s Medicare Advantage program performs across the various HEDIS quality measures on a five star scale. Based on the star ratings, health plans are eligible to be paid bonuses.