Year Round Prospective HEDIS® With Astrata

Apr 20, 2021 | Solutions

Instead of spending most of their time reviewing thousands of negative cases, your abstractors can spend almost all of their time closing gaps.

Is your organization contemplating the move to prospective, year-round HEDIS on hybrid measures during the off-season? If so, you’ve probably been doing a lot of math. With the enormous number of gaps to close across even a moderate-sized population, the economics don’t add up. Using our current-sized abstraction team to work during the off-season might not make a dent. How can we afford the additional abstraction costs?  Is it really possible to scale prospective review across an entire population? 

Drum roll please….we have bad news and good news.

Bad news first…

No, your methods and process for HEDIS Sample Season won’t scale across your entire population. The math is working against you. It would take a 5-abstractor team nearly 1,000 days to review every closeable gap for a moderately-sized population. 

Number of charts to review 500,000
Estimated number of gaps to close 50,000
Average number of charts reviewed per abstractor per day 100
Abstractor days to close all gaps 500,000/100 = 5,000
Number of abstractors on team 5
Number of days for team to close all gaps 5,000/5 = 1000

Now the good news…

Yes — it’s absolutely possible to do prospective, year-round review on hybrid measures with lightning efficiency, even scaling across entire populations. But your team will need to work in very different way: using a technology-enabled platform. That’s where Astrata’s technology comes in.  

The answer is simple – let our HEDIS-focused natural-language processing software read the medical record first. Our Chart Review product will tell your abstractors which cases they should prioritize because they have enough information to close the gap. And it will help them get to HEDIS-required evidence in the medical record in just a few clicks. Instead of spending most of your time reviewing thousands of negative cases, your abstractors will spend almost all of their time closing gaps. Studies of real HEDIS abstractors have shown that they are able to close between 6 and 38 times the number of gaps per hour using our platform. Math looking better? Improve your rates throughout the year, get topsight into difficult measures with time to intervene, and reduce the stress of sample season.  

Number of charts to review 500,000
Number of charts Astrata flagged for review 55,000
Estimated number of gaps to close 50,000
Average number of charts reviewed per abstractor per day 100
Abstractor days to close all gaps 55,000/100 = 550
Number of abstractors on team 5
Number of days for team to close all gaps 550/5 = 110
Now we’re talking!


Reduce the Abrasion 

Your providers will be happy to see better rates, but not at the cost of constant interruptions to their work for additional documentation. If you’re already experiencing provider abrasion with HEDIS, you won’t want the abrasion to scale with your record review. Astrata technology helps you separate cases where you have all the evidence to close the gap (we call those Hits) from those where you have some but not all the evidence (we call those Leads). For example, a member with an IMA gap has a telemedicine note on 4/6/2021 that says “Menveo vaccine – COMPLETED 4/6/21”. Astrata’s software knows vaccines cannot be administered via telephone/telehealth visits, so it would call this a Lead. Abstractors can filter for Leads by provider,  and focus provider outreach on high priority cases where they can make an impact, while skipping the cases that are obviously hits or exclusions. 

Use one Platform

If your organization is already thinking strategically about collecting quality data to support your value-based care arrangements and maximize your quality incentive payments, then you are likely already thinking about how to centralize clinical data for prospective HEDIS. Astrata provides the platform you need to integrate this data and create one consistent view across the multitude of different medical record systems. 

Get the Big Picture

Year round HEDIS is all about prioritizing. How many gap-closing opportunities do I have across all my measures and populations? Will closing exclusions help or hurt my rates? Where should I start first? Astrata’s technology and consulting practice helps you answer those questions. Pull your own Opportunity Reports and set yourself up for success with a population-level analysis of remaining Hits, Leads and Exclusions in your system. Now you can prioritize and plan, with the confidence that you’re maximizing the value your year-round team can produce. 


The future of Astrata’s technology will go even further to help you optimize your prospective abstraction using a wide range of features, now fully under your control. Our Optimize product is expected to be released at the end of 2021, helping you prioritize measures with lower rates, greater risk to your Star ratings, or of more benefit in achieving your health equity goals. Soon, you’ll be able to implement your strategic goals and see them translated immediately into workflow.  


Read this next…

Six Reasons to Start Your Digital Transformation with Prospective HEDIS® Review

Navigating the transition to Digital Quality is like crossing a fast-moving stream. You want to get across without falling in and getting washed away! You may not know how long it will take to get across, but you don’t want to be stuck on the shore when the water...

Tackling Prospective HEDIS Review – Tips and Tricks

Many payers are either experimenting with or fully implementing a prospective HEDIS review process. If you're looking for strategies to optimize your prospective review, these ten tips and tricks will help you derive maximal value. Many payers are either experimenting...

Unstructured Data and Health Care Transformation

Last year ChatGPT exploded on to the scene, kicking off a flurry of technology development with impact across many industries. The technology underlying ChatGPT (known as large language models or LLMs) has actually been around and evolving for several years. And these...

Why NLP should be part of the Digital Quality transformation

This month's blog talks about the importance of unstructured data to achieving digital quality. Unstructured data is clinically valuable and likely here to stay, and NLP can help us embrace it to improve quality. The journey to digital quality is first and foremost a...

Why 2023 will be the watershed year for Health Plan Quality teams transitioning to Digital Quality

This month we are going to discuss what it takes to stand up a digital quality program. Most health plans are somewhere on this transformative journey, either in the planning stages or starting to experiment with potential models. If you are one of these health plans,...