10 Essential Steps to Prepare for HEDIS® Measurement Year 2024

Are you ready to tackle the challenges of HEDIS® Measurement Year 2024 (MY24)? Whether you are a seasoned expert or brand new to the Healthcare Effectiveness Data and Information Set (HEDIS), preparing for a new reporting season can be daunting.

Between evolving regulations and adapting to new policies, new requirements and technologies, and an ever-growing amount of disparate member data that needs to be identified - how you spend the next few months will have a significant impact on the efficiency, effectiveness, and success of your HEDIS reporting program for MY24.

Your HEDIS reporting checklist for MY24

As a former HEDIS compliance audit policymaker, I understand the complexity of planning for each new reporting season. To help your organization prepare for successful and stress-free HEDIS reporting in MY24, I have compiled a list of my top 10 recommendations.

1. Understand reporting changes

Your first step ahead of any new HEDIS reporting season is to ensure you have adapted to any changes or updates in the National Committee for Quality Assurance (NCQA), the Centers for Medicare & Medicaid Services (CMS), and State Medicaid reporting requirements. Below is a list of things to consider when evaluating what has changed:

• Know which HEDIS measures have been removed or added, including changes to any hybrid measure requirements or electronic claims data systems (ECDS) measures.
• Understand specification changes and how those changes impact data extracts, data mappings, and downstream audit requirements.
• Consider working with an experienced vendor who can help you quickly navigate year-to-year changes.

2. Conduct a "vendor check-up"

It's important for health plans to review their vendor contracts ahead of the new season, including those for medical record review (MRR), electronic health record (EHR) data, lab data, and state immunization data, to name a few. These check-ups ensure you are positioned to collect complete and accurate data to support successful reporting and adherence to regulatory and HEDIS program requirements. Now is also an excellent time to consider ways to lessen vendor management and oversight burden through vendor contract consolidation. Consolidating quality and risk adjustment gap generation into one engine can reduce your operational overhead for member and provider outreach.

3. Enhance direct and indirect data collection efforts

Health plans are required to submit race and ethnicity stratification data for many quality measures. The number of measures that require this stratification has increased. While direct data sources are preferred, NCQA continues to permit health plans to use indirect data sources for reporting. In preparation, health plans should consider effective approaches to improving direct and indirect data collection. For instance, Inovalon's Race & Ethnicity Data Enrichment Services enables health plans using the Inovalon ONE® Platform to enrich and integrate indirect data to support the reporting requirement.

4. Check your MRR chase logic

Outside of having complete and accurate data, the MRR component of HEDIS is critical for hybrid measure calculation. As part of the process of loading and running measures as early as possible, plans can also proactively create a mock MRR project to assess their chase logic, identify gaps in their provider demographic data, and evaluate any modifications that may be needed. It's essential to understand the changes in the measures from one reporting year to the next and how those changes impact your chase logic. Conducting this type of proactive review helps ensure plans are directed to the proper medical record the first time around.

5. Identify more supplemental data sources

As health plan quality teams are all too aware - claims data is not always complete. Auditors encourage health plans to identify and load additional data sources to ensure data completeness and rate accuracy. Consider implementing a year-round medical record review to contribute to supplemental data collection. This data can also be used for population health management initiatives and to inform underperforming areas you need to target for improvement.Are you maximizing your electronic clinical data sets to reduce chart chases in season and improve your ECDS measure rates? Having the right vendor to collect and parse the data needed from your continuity of care documents (CCD) data is critical. Learn more about Inovalon's Electronic Record On Demand to support HEDIS supplemental data.

6. Start working with your auditor early

Your auditor is required to review and approve any material changes you make to data mappings, provider specialty code mappings, supplemental data sources, hybrid oversample rates, etc. Give them plenty of leeway to review - and yourself a chance to breathe - by engaging early and getting these processes approved now. Your team and auditor will thank you when you are ahead of the game during the pre-season rush for auditor approvals!

7. Proactively look at HEDIS measure rates

Increasingly, health plans are taking advantage of an early start to the HEDIS season by running a preview of new measures and those that changed in their prospective quality programs. Don't be caught on your heels when you can review your rates early, identify gaps, and proactively intervene to ensure members are compliant before the start of the HEDIS production season. Inovalon has a HEDIS MY24 Preview Catalog available today, ahead of the fully certified HEDIS MY24 catalog release.Additionally, Inovalon's Converged Analytics Benchmarking solution provides insight into your plan's prospective measure performance compared to the industry averages.

8. Clean up your provider data now

"Dirty" provider data is a common challenge in health plan MRR projects. Start assessing and cleaning up your data now to improve efficiency and avoid extra administrative burden once HEDIS reporting season begins. Accomplish this by creating a mock MRR project off a pre-season data run. Export providers relevant to your MRR project and begin standardizing their addresses, phone numbers, and fax numbers. Also, consider creating and testing location roll-ups to streamline chart pursuits, reduce costs, and prevent provider abrasion. Incorporating these steps early in the process will facilitate a great start to the upcoming HEDIS reporting season.

9. Understand and address staffing needs

Now is the perfect time to think about staffing requirements for the upcoming season. Evaluate your current roster and consider your strategy for ensuring you have appropriate and experienced resources in place to exceed program goals. Maybe you need to add nurse reviewers to your roster to support an expanded hybrid project. Or perhaps you were not fully satisfied with the experience and skills of your MRR staff in the prior season and need to add a more robust training program in preparation for the upcoming HEDIS reporting season. Evaluate your current roster against your project goals to inform your needs. Start recruiting now!

10. Be a good HEDIS data steward

Good HEDIS data governance and stewardship are critical for accurate HEDIS measure reporting. Effective data governance ensures that data is consistently managed across the organization; owners are assigned to each data set, which includes integrity and accuracy. Those owners should be able to speak to the origins of the data and how it was used or impacts HEDIS reporting.HEDIS data stewardship involves the careful and responsible management of HEDIS-related data, ensuring its quality and compliance with regulatory standards.Given the challenges from the HEDIS MY23 reporting season, there will be an increased focus on good data stewardship. It's always important to remember that your members' data must be protected. Unfortunately, cybercriminals also know how valuable this information is, making healthcare organizations a target for attacks.According to research from Stanford University, 88% of data breaches are caused by human error. This means that it's essential for you and your team to practice good cybersecurity hygiene:

• Periodically change passwords
• Don't click on hyperlinks from suspicious emails
• Limit HEDIS data access only to those who need it to perform their job functions

The bottom line: The earlier you can get started and the more proactive you are, the smoother, more efficient, and more successful your quality reporting efforts for MY24 will be.

Achieve your quality measurement and reporting goals with Inovalon

Having a partner in your corner with the experience and expertise to handle all phases of the HEDIS reporting season helps relieve the pressure of this time of year. This is why more than 100 health plans choose Converged Quality, Inovalon's HEDIS software solution, which processes nearly 189 million lives, including more than 80% of all HEDIS-covered lives. ¹

Inovalon has achieved 23 years of NCQA HEDIS Measure Certification, remaining the market leader in quality reporting and the vendor most selected by NCQA as a beta test partner.

Now is the time to start planning for the new HEDIS reporting season. Are you ready? Contact us to schedule a demo today.

Sources:
¹ Inovalon calculation based on HEDIS® MY2022 data. July 2023.

HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA).

Inovalon and design®, Inovalon®, and the Inovalon ONE® Platform are trademarks of Inovalon, Inc.

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