BHA Improving Quality Scores

One of the largest insurers in the country, a 5-state blue, knew their members were getting high quality care. But their Star Ratings and HEDIS® hybrid scores in Medicare Advantage weren’t showing that.  They asked Baltimore Health Analytics if we could help them and we did.

We have an ongoing engagement, but we wanted to share how we’ve worked together with BHA’s tools to markedly improve their quality scores.  The truth is, we’re more heavily engaged than ever, now working with their other lines of business.  It’s become a cliché to call clients “partners,” but the idea is very true here.  Their success is our success, and we’re proud to share a snapshot of how we’ve done so far.

Our initial interactions started with a small task.  Kick the tires of their existing processes and make some recommendations for HEDIS® improvement.  Second, provide reports to track whether they’re hitting the numbers they need to achieve both Stars goals and CMS’s statistically significant improvement in as many measures as possible.  Third, create a shadow chase list from claims to compare with chase list generated by the hybrid reporting system. 

From this, we demonstrated that a claims based chase list for labs would catch end of year labs and 3^rd party labs that the standard CDC chase list was missing.  “What use is that?” “We can automatically generate faxes based on the additional chases.” They replied, “Go for it”, and their A1C rates jumped an average of 13% in the first year.

The second year was more of the same.  BHA would supply daily tracking of HEDIS® and augment their ad hoc reporting and their HEDIS® leadership team during the crunch.  They also licensed 2 tools from BHA.  BHA Ocular uses Optical Character Recognition (OCR) to guide the users to quickly find and abstract hits in charts.  This yielded a triple benefit.  For starters, it’s just a faster system to work in.  Additionally, they were able to find hits that sometimes get overlooked, like an ABA from a CDC chase.  Finally, it let them look at charts that they otherwise wouldn’t have time to search - risk chart, prior year HEDIS®, etc which include hits but so few hits/page that it’s otherwise not worth the time.

BHA Pisces (get it? - fishing/fish and “stars” reference) lets plans generate formatted chart request letters and manage their collection effort.  A supervisor assigns providers to chasers and monitor progress.  They can make sure that faxes are generated and returned and get to closure in a timely manner.  Users can activate inactive and shadow chases on the fly, merge provider records into one fax, and generate chase letters in different formats. 

We achieved a second year of strong improvement -- notably HEDIS® measures started contributing to higher Star ratings instead being of a drag against them.  Since then, BHA Ocular has given the client a platform to move to year round chart review.  250,000 OCR and human reviewed charts later, we’re at the start of another HEDIS® season poised for another jump. So far, so good -- we can’t wait until this year’s score get finished and published so we can share how it went.

Email us for a demo of BHA Ocular, BHA Pisces, our free online Stars Tools or a discussion about how BHA can help you achieve higher scores.

About Baltimore Health Analytics

Baltimore Health Analytics provides tools and in-depth subject matter knowledge to assist health plans with improving Star Ratings.

Check out all of our free Stars tools and other in-depth content at www.baltimorehealthanalytics.com