These rates then serve as a basis for physician profiling and incentive programs. We take the privacy of our members very seriously, and we appreciate that you do, too. HIPAA compliance of the highest importance to us! This is because the disclosure is a part of quality improvement and assessment. We handle all patient information carefully with an ethical and legal focus on protecting, preserving and maintaining the highest standards of confidentiality.
Claims are the major source of data, but specific measures may also allow plans to survey members or to access member medical records for additional data not captured in claims. This type of data collection combined claims and chart data is called hybrid. Final health plan ratings for all lines of business are published on the NCQA website by October The scores on measures can help them understand quality of care being delivered to their members in some of the most common chronic and acute illnesses.
Higher scores can help compete more effectively in various markets. HEDIS score reporting are often required in public markets as well, where the results are often reported to the states, or occasionally counties, in which the plans reside. Pharmacy measures focus on medication management of acute and chronic physical and mental illness, appropriate medications in the elderly, and management of polypharmacy.
Specialty measures are directed toward inappropriate imaging. Aside from being a collection and reporting contract requirement for many of our customers and our own health plan, HEDIS gives Magellan valuable information about the populations we serve. By following the behavioral health data, we collect, for example, we can identify gaps in network performance in patient follow-up patterns, management of drug and alcohol abuse, and prescribing and adherence to medications. Measures cover aspects of healthcare including preventative care, such as screenings and immunizations, management of physical and mental health conditions, access and availability of care, patient experience, healthcare utilization, and resource use.
The scores on measures can assist health care plans to understand the quality of care provided to their members in the most common chronic and acute illness populations. There are three sources for HEDIS data collection, although the majority of data is derived from billing claims.
Although billing claims are the major source for data collection, specific measures may allow plans to survey members or access medical records for data that are not readily available in claims. The goal is to encourage providers to submit claims with accurate coding that captures all the data required by HEDIS through administrative efforts to decrease or eliminate, the need for a hybrid review.
The three sources for data collection include:. To compete in markets, achieving higher HEDIS scores is helpful to encourage more consumers to choose a specific health plan.
HEDIS measures have certain documentation requirements and specific parameters that contribute to the score. These scores are improved through the provision of timely and appropriate patient care with clear, accurate documentation in the claim codes of all the healthcare services provided.
Most providers choose healthcare to serve their patients, not specific standards. But a lack of awareness and not instituting efforts to meet quality and preventative care requirements can negatively impact HEDIS scores.
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