Why you don’t need an army to improve HEDIS performance

More than 90 percent of payers in the United States use the Healthcare Effectiveness Data and Information Set (HEDIS) to measure the efficacy of value-based healthcare. Similarly, the Centers for Medicare & Medicaid Services (CMS) uses a five-star quality rating system to measure patient experiences across health plans and providers.

Naturally, it’s hard to overstate the importance of such quality measures. They drive not only where patients receive care, and why – but how networks are paid for providing that care.

But for forward-thinking pharmacy leaders, quality measures aren’t just boxes to check or hoops to jump through. Rather, they present opportunities to strengthen underlying infrastructure, level-up patient satisfaction, and address gaps in delivering the care critical to patient health. 

And best of all, improving HEDIS performance doesn’t take an army of pharmacists or clinicians – it just requires the right partner with the right technology.

In this post, we’ll look at three steps for working with a trusted partner like RxLive to help improve HEDIS performance and improve how your network meets its benchmarks.

#1: Identify the right patients

All patients deserve quality healthcare. That’s a simple fact. More complicated, however, is how value-based leaders plan for and provide care for their entire network’s empaneled populations. 

We’ve written before about how identifying the right patients, at the right time, powers efficient, effective individualized care plans. So it should come as no surprise that a similar approach helps achieve the positive population-level outcomes HEDIS scores are based on. 

The data, to turn a phrase, is in the details.

Designing an individual care plan, for example, might depend on reviewing data identifying a patient’s risk for stroke, then intervening with a personalized consultation. The population-level strategy, however, doesn’t simply depend on identifying risk. Rather, it’s a multi-step process:

  1. Select top x% of patients by risk of stroke
  2. Select top x% of patients by stroke risk reduction
  3. Select top x% of patients by a combination of stroke risk and stroke risk reduction.

Stratifying concurrent populations of empanelled patients in order to reduce risk for the population overall might seem daunting. But RxLive helps partner networks integrate Surescripts and EHR data through automated processes. 

Then, care teams can use RxLive.ai to run analytics on that data for key insights that help guide courses of care (i.e., identifying not just those patients at risk of stroke, but also those whose risks can be effectively reduced).

#2: Activate patients to realize positive outcomes

A rising tide lifts all boats – and likewise, as we touched on above, proactive outreach to individual patients has an impact on the population level.

The problem: outreach takes time. And time in healthcare remains at a premium. So your cardiology team may be able to find the time to gather and sort the data necessary to reduce their patients’ overall risk for stroke. But if they do, it’ll be hard to find the additional time to activate those patients through proactive outreach.

But RxLive doesn’t just offer the technological solutions that power innovative value-based care. We’ve also developed a fractional network of pharmacists to help scale your pharmacy program. 

With RxLive’s value-based pharmacy strategy, additional pharmacists virtually embed in your network’s existing care team. Then, these pharmacists can assist with work ranging from patient consultations via telehealth, to medication reconciliation, to EHR review.

With My.RxLive’s data and RxLive’s fractional network of pharmacists integrated into your workflow, you can improve population-level outcomes without adding additional work for your team in the clinic.

What’s more: improving care leads to higher patient satisfaction (an important HEDIS measure). RxLive can help you document and report all outcomes, from patient satisfaction to medication management to hospitalization rates. Next, let’s look at how.

#3: Document positive outcomes to demonstrate quality care

When it comes to delivering care, identifying and treating the patients who need intervention is the whole ballgame. But while quality measures are tied directly to patient outcomes, accurate scores aren’t achieved by patient health alone. Rather, they require accurate documentation.

For overworked care teams, that’s a problem – and an especially human one. There’s enough administrivia in healthcare – no one wants to add additional paperwork to the hours they already spend charting. And what’s more: as we’ve discussed, clinicians simply don’t have the time.

With RxLive’s technology, however, care teams can document, for example, cardiatric HEDIS measures including…

  • Controlling high blood pressure
  • Persistence of beta-blocker treatment after a heart attack
  • Statin therapy 

The upshot: with our fractional network of pharmacists, this information can be accurately collected, documented, and turned into the reports that demonstrate the positive outcomes your care teams deliver.

And knowing you’ll have this information at hand lets you focus on delivering the quality population-level care that leads to better HEDIS scores – leading, in turn, to improved patient satisfaction and increased revenue.

Embrace quality measures to deliver refined care

CPOs often challenged by their executive teams to develop programs that bring to the table – and as we well know, they’re often asked to make tough financial choices, too.It’s easy to take the glass-half-empty view and to look at quality measures as an administrative means to a financial end. But with the right approach, systems like HEDIS can help networks refine a sustainable model for delivering patient care – as well as measuring its impact.

Kristen Engelen, PharmD
Kristen Engelen, PharmD, is the chief pharmacy officer of RxLive and a certified consultant pharmacist; she has over a decade of experience in retail pharmacy settings. Kristen became an RxLive co-founder because of her passion for geriatric pharmacy, with a focus on the intersection of pharmacy and aging.