Blog

/

For Enterprise

/

5-Step Guide To Improving HEDIS Quality Measure Performance

5-Step Guide To Improving HEDIS Quality Measure Performance

preview_image
Take the next step to feeling better
Get started

According to Health Payer Intelligence, The Healthcare Effectiveness Data and Information Set (HEDIS) is used by more than 90 percent of health payers to assess and collect data on the performance of providers. The healthcare industry is experiencing a much-needed shift from a fee-for-service payment model to value-based care to ultimately close the gap between the quality of care and reimbursement. HEDIS quality measures play a crucial role in helping payers to be successful and competitive in a now patient-centric, value-based care environment. HEDIS scores allow consumers to compare the quality of healthcare plans from a birds-eye view of the majority of health plans in the country.  This blog includes a 5-step guide to improving HEDIS quality measure performance for payers.

5 Actionable Steps to Improving HEDIS Score:

The impending question for health plans now is: How do we improve our HEDIS score to appeal to more customers and employers in such a competitive environment? NCPA reported that 191 million people are enrolled in plans that report HEDIS results. Knowing this, HEDIS is one of health care’s most widely used performance improvement tools. The following 5 steps will help you understand how to increase your HEDIS score as a payer.

1. Adopt a value-based care model

Not without challenges along the way, payers have worked hard to shift to a value-based approach for several reasons:

  1. Quality of care and mental health services provided
  2. Patient experience
  3. Cost efficiencies

In a recent Healthcare Innovation article about transitioning to value-based care in behavioral health, the moderator at a panel discussion hosted by World Congress said that the traditional fee-for-service environment is focused on getting the consumer to pay more. Whereas value-based care allows us to reimagine patient outcomes, by looking at the whole comprehensive picture of what impacts outcomes, and how to reconfigure the reimbursement structure based on the quality of care and patient outcome data.

Example of a value-based care model

Each patient is unique and deserves an individualized care plan.  Reimbursement models should mirror that to incentivize providers to provide high-quality care to everyone. Here’s a look into Cerebral’s approach for current health plan clients that considers patients experiencing varying levels of mental health condition acuities:

  • Mild and moderate conditions - Patients who experience mild to moderate conditions fall under a “pay-for-performance” approach. Providers will receive a financial incentive for operational and quality performance (i.e. speed to care, assessment improvement and completion, and HEDIS measures).
  • Severe (high acuity) conditions - Patients who experience severe mental health conditions are part of a “pay-for-value” approach. Reimbursement is based on the value of care provided by showing reductions in visits to ER and in-patient visits and the decrease in total costs of care.
  • Severe subset (e.g., SMI/SUD) - The subset of the severe acuity patients is categorized under “case rate” reimbursement. These mental health conditions drive high costs of care. Providers are accountable for the overall health of these patients by treating them under specific care models that ultimately help reduce the total cost of care. 

2. Streamline documentation for HEDIS reporting

Although documentation is one of the most crucial steps to improving your HEDIS score, it’s extremely tedious. A big hurdle for healthcare providers and payers to make the shift to value-based care is the amount of administrative work involved in documenting the correct information for reimbursement, and the professional burnout or lack of bandwidth for the current staff to adequately collect data for HEDIS and reimbursement.

This detailed 2022 HEDIS documentation and coding guide provides information necessary to remain compliant with HEDIS measures, documentation, and reporting.

To streamline and automate documentation, you must consider integrating technology into your data collection and documentation strategy. For example, Cerebral has a proprietary EMR for collecting data in multiple important categories, including patient engagement, clinical outcomes, clinician activities, and clinical safety measures (i.e. medication fill rates, patient engagement on clinical surveys, lab ordering frequency for medication that requires lab monitoring, etc).

3. Screening and monitoring for HEDIS quality measurement

In addition to documentation, you should have a way to screen and monitor document outcomes for quality measurement. You should be able to answer questions in real-time like:

  • What are the current readmission rates to emergency rooms, and how have the rates improved?
  • Do patients have access to medications with their providers, or do they have to be referred to an in-person psychiatrist?
  • Are providers able to offer low to high acuity levels for varying levels of mental health conditions?
  • What is the time to access to care when patients are seeking help?
  • Do patients have convenient access to care (i.e. virtual care rather than traditional in-person care)
  • Are your positive patient outcomes rates increasing?
  • How exactly have you decreased overall healthcare costs?

If you aren’t able to answer these questions within minutes, chances are, you need a software solution to provide more visibility into the total view of each patient’s episode of care comprehensively to effectively demonstrate in HEDIS reporting, and successfully shift to value-based care.

Example of how to screen and monitor for HEDIS quality measurement

As an example, the technology used by Cerebral health plan partners tracks metrics that impact HEDIS measures.

First, patients are matched, assessed, and begin receiving care in the same time period.  We track the first assessment completion and corresponding diagnosis codes that are tied to HEDIS measures such as ASF, IET, AMM, and ADD.

During the “treatment and measurement phase”, we track metrics from continued assessments and a 7-day follow up which impacts HEDIS measures DMS, DDE, and SF.

Finally, while in the “maintain and monitor” phase, we evaluate 90 days for avoided emergency room visits and in-patient visits, while maintaining remission, which positively impacts HEDIS measures MPT, IAD, FUA, FUH, FUI, and FUM.

All data that we screen and monitor is documented and packaged up for HEDIS reporting, eliminating consuming and manual administrative work.

4. Increase provider and patient engagement

By interpreting information collected from screening and monitoring patients and provider engagement, health insurance companies have the opportunity to identify current areas of opportunity for improvement, that will lead to better patient outcomes, and long-term cost efficiencies.

Below are a few examples of data points that Cerebral looks at to identify gaps in provider and patient engagement, which patients need care or higher engagement, and how providers can adjust care plans to fit patient needs.

Cerebral provider engagement metrics
  • Visit note submissions
  • Prescription entries
  • Lab orders
Cerebral Patient engagement metrics:
  • Clinical survey fill rate
  • Mobile app usage
  • Use of educational materials
  • Communications with the care team
  • Medication fill rates

5. Increase reimbursement for payers and providers

We know by now that the value-based care model is built on the premise that healthcare providers will put focus on the quality of care of patients. To increase reimbursement, providers and payers must provide the highest level of mental health care to patients.

Organizations that can demonstrate improvements in patient outcomes will experience higher reimbursement rates. Patients who have access to high-quality mental healthcare quickly, are less likely to be admitted into a hospital for additional care, which reduces readmissions rates, as well.

What qualifies care as high-quality mental health care? There are several important drivers. In our whitepaper, Leveraging Data Science to Reimagine Mental Health Delivery, we break it down:

High-quality care indicators for patients:
  • Speed to care - Cerebral connects 90% of patients with mental health specialists within 5 days
  • The right level of care, at the right time with individualized treatment plans (Cerebral offers regimens that include medication management, therapy, and counseling as needed)
  • Medication adherence - Cerebral has achieved an overall medication adherence rate of 94% by sending medication directly to patients’ homes
  • Diversity among clinicians to create a welcoming environment for patients - 50% of clinicians at Cerebral identify as non-white, which makes us the most diverse behavioral health provider in the industry.
Incentives

Psychiatry is one of the lowest salaries among all clinician specialties. There is very little financial incentive to care for populations with high-acuity conditions in the traditional payment model, creating problematic disparities for select populations  Value-based care motivates evidence-based clinical practice through incentives

The article, Clinician Responsibility in Value-Based Payment Systems, states that incentives drive innovation by:

  • Encouraging health systems to invest in training to improve clinical expertise and skill by use of the measurement-based care facilities system
  • Improved workflows, higher patient engagement, and sophisticated technology to improve work efficiency and communication
  • Improved patient outcomes through care coordination and management between appointments as a patient engagement strategy

According to Driving Quality in Behavioral Health Using a Closed Loop System, it's essential to have a comprehensive data infrastructure in place that collects patient engagement, clinician behaviors, and medication fill rates. In the case of health insurance companies, tools like Cerebral can be integrated into claims data to develop an even better understanding of which patients need care, and to identify patient subpopulations that could benefit from clinical outreach, ultimately improving clinical outcomes and reducing healthcare costs.

If you have additional questions about how to improve your HEDIS score, we would love to connect. Visit our payer page to learn more about how we can help you meet HEDIS quality measures or reach out to our Director of Commercial Health Plans, Lynn Blau at lynn.blau@cerebal.com for additional questions.

Get top insights and news from our experts
Helpful mental heath resources delivered straight to your inbox!
You may also like
Sep 20, 2022
For Enterprise
Telehealth and the Power to Revolutionize Access to Mental health care 
The mental health care system is in crisis – overwhelmed in the pandemic’s wake, with patients nationwide suffering from rising cases of anxiety, depression and other disorders. As a result, they are frequently left unable to find psychiatric and behavioral care. Telehealth companies like Cerebral are leading the way in addressing that need, but like any new innovation in health care, there is resistance. Traditional mental health providers feel threatened by this new model, which exponentially improves access for patients across the U.S. The fact is that there’s room and need for both traditional in-person care and telemedicine. Without both modalities, there’s no way we will make a dent in the acute challenges facing people from every walk of life and across the country. Telehealth isn’t a panacea, but it undoubtedly improves access and reduces the stigma associated with services that are out of reach for far too many people. Americans do not have adequate access to mental health care. Nearly one-third of Americans live in an area that has a shortage of mental health care professionals and 60 percent of all U.S. counties – including 80 percent of all rural counties – do not have a single psychiatrist. If patients are lucky enough to secure an appointment, they often have to wait months before their first session.  However, it is typical for non-psychiatrists to treat mental illness. In conventional health care, 79 percent of antidepressants are prescribed by primary care doctors, so it’s a misconception to think that psychiatrists are prescribing the lion’s share in traditional settings. Nurse practitioners have a critical role to play. A key to improving access to care is to use experienced clinicians – often nurse practitioners – who play a vital role in the health care system, especially in underserved communities. As front-line clinicians, nurse practitioners are practiced hands in dealing with many aspects of mental health care, and Cerebral’s nurse practitioners are particularly well-equipped and supported to manage mental illnesses.  Besides being carefully screened and interviewed before joining the Cerebral team, our nurse practitioners receive additional training and clinical support for the treatment of the psychiatric conditions we see most frequently, including depression, anxiety, bipolar disorder, insomnia, and PTSD, among others. Should they want to discuss a challenging clinical situation, they can easily get in touch with a staff psychiatrist within minutes; this ‘second opinion’ line, which we call Curbside Consults, is an innovation that is available to our NPs 12 hours a day, 7 days a week  They are well positioned to monitor and counsel patients throughout the process of initial evaluation, treatment, and recovery.  A new study out this month (September 2022) found that the ranks of psychiatric mental health nurse practitioners (PMHNPs) are surging as caseloads increase. Notably, the number of PMHNPs who care for Medicare patients jumped 162 percent between 2011 and 2019, compared to a 6 percent decline in psychiatrists, which further underscores how important nurse practitioners are to match the burgeoning demand for care.      By utilizing nurse practitioners and telehealth, we are democratizing access to care, and supporting patients who have historically been disenfranchised by the mental healthcare system.     .  Indeed, nearly 2/3 of Cerebral patients have never had the privilege of receiving mental health care prior to coming to Cerebral. We can only improve what we measure. The vast majority of mental health professionals do not measure clinical outcomes. This would be unacceptable in any other field of medicine: you wouldn’t trust a diabetes doctor who did not regularly check your labs in order to monitor the progression of the disease. Why should depression or anxiety disorders be treated so differently?  Telehealth allows us to measure clinical outcomes using  tools that are integrated within the care experience. By monitoring how patients are doing via surveys, we are able to better understand whether treatment plans are working, or whether adjustments need to be made. Overall, knowing how patients are doing helps us improve clinical quality and maintain patient safety. Collecting patient outcomes data at scale can also be a benefit. It can establish new baselines for what is most effective for different types of patients, paving the way for the kind of precision medicine approach that has transformed cancer care and other specialties.         The bottom line is that the current mental health care system can’t improve access for desperate patients who desperately need care. While there have been missteps and necessary learnings along the way, telehealth has a vital role to play in this process. For tens of millions of Americans who need our help, their well being, and their lives, are on the line. 
Read more
Sep 14, 2022
For Enterprise
How Telehealth Can Increase Access to Mental Healthcare for College Students
Millions of students are set to return to college campuses all over the country over the next few weeks. While this is an exciting time for many students, it can be a challenging one as well, and one that has only been complicated by the effects of the pandemic. According to the CDC, three out of four Americans between the ages of 18 and 24 now report poor mental health resulting from the pandemic. This is among a population that is already more prone to mental health issues, with significantly greater portions of young adults in college reporting struggling with conditions such as anxiety and depression than their unenrolled peers. For example, a recent survey conducted by Fortune found that 43% of college students report struggling with anxiety and 33% report struggling with depression, compared to 29% and 27%, respectively, of US adults in general. Suicide and suicidal ideation rates are also especially high in college students: according to the National College Health Risk Behavior Survey, 10.3% of respondents reported seriously considering attempting suicide, 6.7% had made a suicide plan, and 1.5% reported they had attempted suicide one or more times in the 12 months preceding the survey. The good news is that many students suffering from these conditions see the value in seeking support from mental health care providers. According to a recent survey, 60% of prospective college students now say that mental health services are a very important factor in their search for a university, a statistic that has jumped significantly in the wake of the pandemic. University presidents and leadership also recognize the need: according to the American Counsel on Education, 68% of university presidents view student body mental health as one of their most pressing issues. The bad news is that, despite that awareness, many universities struggled for years to adequately meet that demand, making access challenging for students and creating barriers to care for many. The reason for this gap is largely due to resourcing issues. Most schools only offer in-person counseling options, and there are simply not enough credentialed providers to go around. Colleges have attempted to address this in the past by triaging patients through a “stepped care” model, under which students initially receive the least resource-intensive form of care and are only allowed a more fulsome approach if it is deemed necessary. Other schools have capped the number of sessions an individual can schedule with a provider in an attempt to free up appointment time. Either way, it is clear that there are not enough traditional mental healthcare resources to meet the needs of America’s college students. This is where telehealth and Cerebral come in. As a telemental health care provider, Cerebral can help plug the resourcing gaps that many colleges are experiencing. Cerebral provides students suffering from mental health issues with the ability to book an appointment with a provider within days, alleviating some of the historically lengthy wait times for college counseling services. Cerebral is also able to quickly adapt to a patient’s needs, allowing students to increase or decrease their care as needed and without restrictions. Furthermore, students can now receive care in the comfort and privacy of their dorm, which will lower the threshold for seeking care. Some students find it intimidating or shameful to walk into the counseling centers. We already actively partner with a number of universities to offer this kind of hybrid approach to mental health care for students. For example, we partnered with Arkansas Colleges of Health Education (ACHE) to provide all students access to Cerebral’s telehealth services. A hybrid approach such as the one deployed by ACHE should be considered the future of mental health care on college campuses as university officials continue to look for ways to expand access and meet demand among their student populations. College is a stressful and intense time for many, and adequate mental health support can make navigating it all the more manageable.
Read more
Sep 9, 2022
For Enterprise
Age Verification and What it Means for Access to Care
At Cerebral, we work hard to implement one of the best age and identity-verification processes in the telehealth industry, one that meets or surpasses legal requirements while helping patients access mental health care within days. Our process is an improvement over your typical brick and mortar facility, where ID checks are done manually by front-office staff. The verification process is not without friction, however, so it is our goal to create a seamless process that doesn’t restrict access for the patients who need it most. Improving the verification system is not a simple undertaking but we are working closely with providers and using the latest technology in-house to ensure we treat only those who are eligible for care. Our process begins with a manual ID review for new patients by clinicians, who also verify identifiers such as birthdate and address, and then compare photos to prospective patients by video. If a health care provider can’t definitively confirm the data, we direct providers to let prospective patients know we cannot serve them, and promptly cancel their account and make refunds. As an additional level of security, we ask individuals to upload images from a government-issued identification document (such as a passport or driver’s license), which we then compare to live photos of their face using Persona, a sophisticated software program that is a further safeguard in recognizing accounts of those who are under 18. This system is an important part of any new patient experience at Cerebral, but it is especially critical to ensure that we do not provide services to patients under the age of 18.  Psychiatric and behavioral issues affect people of all ages, not just adults, and access to mental health care for those under the age of 18 is especially complicated. In many states, children are prohibited from receiving care without the consent of their parents or legal guardian. At Cerebral, we do not work with patients under the age of 18. The advent of telehealth has brought new possibilities to our field, but also new challenges, such as age verification. We are dedicated to improving access to mental health care services wherever we can, while going above and beyond to ensure compliance with all applicable laws. We are constantly refining and improving our safety and quality measures to ensure we deliver best-in-class care so that our patients can feel better, sooner, and so that we can help our patients achieve positive clinical outcomes.
Read more
View more posts
Mental health care made for you
Find a therapist or prescriber to get the care you need.
Get started
mental-heath-support

Call 911 if you’re having a
mental health emergency

Text Home to 741-741 if you're in emotional
distress and need immediate support

Call 988 For National Suicide
Prevention Hotline