It's Not Too Late To Use Ocular For HEDIS - A Proposal

HEDIS® is coming up fast. If your organization is still abstracting charts the same way it’s done it for decades, why? Could your team review more charts, improve reliability, get higher scores and get some sleep next April? Of course. Let computers handle more of the tedious work and free up your clinical reviewers to do more clinical reviewing. But isn’t it too late?

BHA Ocular is an abstraction system that uses character recognition to locate potential hits to review, has powerful QA capabilities, and is all around nicely designed for intuitive and efficient use. There are other abstraction apps out there. Ours is the best, but this post is not about the features of Ocular. Let's schedule a demo for that.

Instead, I want to show you that it’s still possible to put it to use this year. Here’s a straw man of a proposal. 

Test it. It’s not unrealistic. It's even padded with a motivated IT and a strong analyst, we could get you up and running in 2 weeks.  

Proposal

From Baltimore Health Analytics LLC (“BHA”) to ________________________ (“Plan”) dated 10/x/2021. BHA will license, install, configure and support BHA’s Ocular abstraction tool to support Plan’s chart abstraction through the 2022 HEDIS season and the subsequent “offseason” abstraction.

Background

Health Plans receive higher quality ratings and higher reimbursements if they can improve performance on certain quality measures. Plan is scored on HEDIS® measures through hybrid abstraction in which Plan will comb medical charts for evidence of certain outcomes that meet the measure criteria (“hits”). Plan will “chase” charts from specific medical providers and - as time permits - may use any medical charts already on-hand.

Ocular is a web-based multiuser platform that can assist Plan in organizing charts, finding hits in charts, and documenting key information. Ocular uses Optical Character Recognition to convert faxes and other formats to Text and automatically searches charts for keywords related to each measure. A high level of accuracy is enforced with an innovative system for 100% double-overread. Ocular output is in both as marked and collated charts for easy review and as a data file that can be fed back into the HEDIS engine.

Deliverables   

 -   BHA Ocular 1-year License on Production and Test/Train Tier

 -   Plan-Customized Training Manual   

 -   Support before, during, and after the HEDIS hybrid season

 Assumptions

   -   10,000 Medicare Advantage Members split into 2 hcontracts

   -   No PHI will be transmitted outside Plan’s secure network

   -   Ocular will be installed on Plan’s computers within Plan’s network

   -   The plan will provide timely access to necessary servers and file

   -   Plan’s HEDIS team and analyst are able to access internal chart sources- The analyst has sufficient access and knowledge to create member and gap files

   -   Charts are accessible on Windows drive with discernable first name, last name, birth date or ID naming pattern

   -   The plan has a 3rd party HEDIS® engine such as Inovalon’s QSI® or comparable for official HEDIS rates

   -   The plan has a 3rd party prospective HEDIS engine for offseason abstraction

Timeline

Software Pricing

Standard Pricing is based on the number of members enrolled Contact BHA for alternate pricing based on Plan's particular circumstances.

Software Requirements 

Responsibilities 

        BHA - BHA is responsible for the Ocular application, training, customization of software code, and general oversight of the use of the tools.

        HEDIS Team - Plan’s HEDIS team is responsible for chart abstraction, QA, and general project oversight.

        Analyst - The plan’s data analyst is responsible for obtaining access to HEDIS data and charts, creating necessary data files to input to Ocular, and running programs to load charts into the Ocular. BHA can supply the analyst if the Plan is able to supply sufficient access.

        IT - Plan’s IT is responsible for configuring and securing the servers, maintaining the operating system, installing 3rd party prerequisite software

        BHA & IT - Responsible for installing BHA Ocular and applying any updates.

 Contract Fees

Next Steps

Send an email to info@BaltimoreHealthAnalytics.com and we'll give you a demo as soon as we can fit in your schedule.

The above project plan, hours, and total cost are for illustration, of course. Your specific needs will adjust it. But we prefer up-front pricing to evasive salespeople. Need more hands-on help? We can do that. Don't need as much? Sure. Want to leave your existing data entry in place (for now) and just use Ocular for screening charts and doing the markup of hits? Of course; we can fit right in and add efficiency into an existing setup. Want a trial run? Let's talk. Got 5M members across multiple plans and states and need to customize? Again, let's talk.