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. 


Read this next…

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,...

Data Quality Primer

In this installment of our monthly series, we’ll dig into the problem of data quality. It’s not all doom and gloom. With some planning, you can get the most out of your NLP vendor while paving a path to higher-quality data across your entire organization. This blog...