Over 90% of U.S. health plans today rely on HEDIS scores to measure patient care and service quality. That's why achieving strong HEDIS scores is a must for healthcare providers. Often times, these scores act as benchmarks for quality, directly influencing funding and resource allocation.

Having partnered with healthcare leaders to secure the talent needed for achieving high HEDIS scores, I understand the importance of building a workforce that can navigate the complexities of patient care and quality measurement. My goal is to highlight why HEDIS matters and demonstrate how a talent partner can be instrumental in helping your organization meet key benchmarks.

Why are HEDIS Scores so Important?

HEDIS scores are important for healthcare providers because they reflect the quality of care delivered at a facility and serve as a key funding indicator. High HEDIS scores can lead to improved reimbursement rates from both public and private insurers, all of which use these scores to evaluate care quality.

Facilities that achieve strong HEDIS scores often qualify for higher reimbursements. For instance, Medicare’s Value-Based Purchasing (VBP) program adjusts payments based on quality metrics, including HEDIS scores. Providers who excel in these metrics can earn bonuses, while those who fall short risk facing penalties.

HEDIS scores are measured on a scale from 0 to 100, with higher scores signifying better performance. The National Committee for Quality Assurance (NCQA) oversees these scores, ensuring that the measures are reliable and meaningful. Now, let’s break down the six domains of care that HEDIS focuses on:

1. Effectiveness of Care

How well do services achieve patient outcomes?

2. Access / Availability of Care

How easy is it for patients to get the care they need?

3. Experience of Care

What is the patient’s overall experience with providers?

4. Utilization and Risk-Adjusted Utilization

How are resources used, considering patient risk?

5. Health Plan Descriptive Information

What does the health plan look like, and who does it serve?

6. Reported Using Electronic Clinical Data Systems

How effective is data reporting through electronic records?

Different Ways a Talent Partner Helps Boost HEDIS Scores

1. Quick Access to Skilled RNs

Finding qualified Registered Nurses (RNs) who understand HEDIS requirements can be a lengthy process. A talent partner can quickly connect you with skilled RNs ready to jump in and make an impact. For instance, these nurses can conduct comprehensive chart reviews to ensure that all necessary documentation for HEDIS measures—like diabetes management or preventive screenings—is complete and accurate.

They can also perform patient assessments to identify gaps in care and follow up with patients to encourage attendance at important screenings like mammograms and colonoscopies. With immediate access to the right talent, you can ensure compliance and boost patient outcomes without the long wait.

2. Expert Help with Data Management

Managing data can feel overwhelming, especially with all the nuances involved in HEDIS. Here’s where a talent partner shines. They can provide specialists who are experts in HEDIS-related data management, skilled in extracting and analyzing data from electronic health records (EHR). For example, these professionals can help track key performance indicators (KPIs) related to HEDIS measures, ensuring that data is accurate and up to date for reporting.

3. Less Paperwork, Greater Patient Care

We all know paperwork can pile up and distract healthcare professionals from what they do best: caring for patients. Administrative support staff from a talent partner can tackle data entry and manage patient communications related to HEDIS measures. For example, they can handle outreach for patient reminders regarding vaccinations or wellness visits, ensuring that patients don’t miss appointments. As a result, your healthcare team can spend more time with patients and less time buried in paperwork.

4. Care Coordination

Boosting HEDIS scores is easier when you have great care coordinators from a talent partner on your team. These professionals can help implement care pathways that ensure patients receive timely screenings and follow-up care for chronic conditions. For instance, they can facilitate connections between patients and specialists for follow-up appointments after hospital discharges, reducing readmission rates—a key HEDIS measure.

Staying Ahead of Important HEDIS Deadlines with the Right Partner

For healthcare leaders, hitting HEDIS deadlines isn’t just another responsibility—it’s a critical review of care quality and subsequent funding. With these deadlines running year-round, the pressure to maintain high standards never lets up. A talent partner can lighten the load, providing skilled support exactly when you need it to stay on track and meet each requirement smoothly.

For the full 2024 HEDIS schedule, refer to the NCQA timeline. If you're looking for an expert partner to help your facility meet those deadlines, click here.