Tools to Raise Star Ratings in the Age of Covid-19

Recent guidance from the Center for Medicare and Medicaid Services (CMS) indicates that even during the pandemic that is Covid-19, they expect MAPD health plans to continue to emphasize clinical and service quality. CMS also indicates that they expect data collection for HEDIS® measures to “return to normal” in 2021.

Whether there is a return to normal or not, it is clear that CMS expects that health plans will be able to generate HEDIS® reports in 2021 related to care given in 2020. Plans need to be taking action now to both assure members are getting care needed, and to make sure that the data sources used for HEDIS® reporting are as robust as possible.

Baltimore Health Analytics (BHA) has two tools available that can assist health plans with both of these goals:

• BHA Ocular for SDS Chart Review – an effective tool to convert existing in-house medical records into supplemental data to close gaps and reduce 2021 chart review.

• Ocular allows staff to quickly review a medical record, find evidence of services in the record, and enter it into a template that is mapped to a non-standard Supplemental Data Source

• Records are converted to a digital image allowing Optical Character Recognition of measure-specific keywords

• Charts gathered as part of Risk Adjustment, prior years HEDIS® record collection, Quality Initiatives, and collected from Provider Portals for HEDIS® gap closure are all excellent sources to mine for HEDIS® hits.

• BHA Rover to quickly spin up a clinical campaign without first installing a full blown EMR

• Rover is a tool that can assist a plan with Medication Adherence projects or to reach out to members in need of services such as Breast Cancer Screenings, Colorectal Cancer Screenings or Diabetic Eye Exams

For information on either of these effective tools to assist your health plan HEDIS® reporting, please contact Kathy Lester, Director of Quality Improvement Consulting at BHA at kathy@baltimorehealthanalytics.com.