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

Jul 31, 2023 | Resources, Solutions, Technology

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 rises. That means carefully and strategically planning your path to the other side.  

Rebecca Jacobson, MD, MS, FACMI

President, Astrata

 Why does Astrata recommend that Health Plans move to a Prospective HEDIS review season as one of the first steps in the transition? This can seem counterintuitive to those who want to go immediately to replacing technology and data flows. So why is it better to start with adding a Prospective review season? Here are six reasons:

1. You already have everything you need to begin adjusting workflows to establish a year-round cadence while you’re still doing a hybrid sample season. For many plans, that means clearing some calendar space from June-January for your abstraction teams to focus on closing gaps across the population for high-priority measures. 

2. You already have the team and most of the processes you will need in place. There’s nothing mysterious about Prospective HEDIS review; you’ll be processing more data, which will require higher efficiency to ramp up to population-wide review without increasing your workload. 

3. If your organization is large enough to be worried about scaling across populations (and that’s most of you), you can introduce an NLP solution, leading to demonstrable ROI and better rates that can help you advocate for further investment. 

4. Most abstraction-enhancing NLP platforms are additive and easier to integrate into your existing HEDIS operations than brand-new technology and dataflows. Starting with a prospective MRR season will get you farther, faster than an infrastructure-focused step.

5. Moving from a primarily reporting-based HEDIS operation to a primarily intervention-based operation is as much a mental transformation as it is a digital transformation. It’s hard to describe the muscle movements involved, and much easier if your teams (abstraction, analytics, management) experience it firsthand. Starting with Prospective HEDIS quickly establishes your trajectory, helping your teams understand in practical terms where you are going.

6. You can learn how to combine your prospective measurement and interventions most effectively before introducing major technology changes (e.g., FHIR and CQL). Improving your Quality Improvement arm with better data is the real game changer. Get started on that first, and then layer in the bigger tech changes. 


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