Strategies for Improving HEDIS Performance: Best Practice From A Primary Care Perspective Alix Bouchette, MD, FAAFP

Practice Goal To provide the highest quality care in order to generate optimal health outcomes.

Healthcare Effectiveness Data and Information Set (HEDIS) HEDIS is a tool used by more than 90% of America’s health plans to measure performance and medical services.

Strategies for Improving HEDIS Performance Working with our medical assistants to capture and submit the clinical data to the respective insurance companies through appropriate CPT and ICD-10 codes. Encouraging members to get recommended care. Improving access to timely, routine care.

Methods Use and submit all applicable codes when evaluating patients. Gap lists from different payers are reviewed on a regular basis Prior to the patient’s appointment, goals are identified and highlighted in front of the patient’s folder. We try not to miss an opportunity to close gaps!

Medications Medications are reviewed at the beginning of each visit and in patients over 65. Recognize and discontinue all potentially harmful drugs such as those included in the Beers’ list. Detect potential drug-drug interactions. Identify opportunities to decrease polypharmacy.

Immunizations Immunization records are also reviewed and age specific immunizations are recommended such as: Influenza vaccine TdaP Pneumovax Prevnar-13 Zoster vaccine HPV and Hepatitis vaccines (when appropriate)

Problem List Updated by adding new diagnoses and deleting obsolete diagnoses. EMR - Epic

Health Maintenance Colonoscopy FOBT (for patients who decline the colonoscopy.) Flexible Sigmoidoscopy Eye Exam Foot Exam Mammogram Pap Smear Bone Density Urine for Microalbumin PSA (optional)

Risk Assessment Once a year a complete risk assessment is conducted for elderly patients. Including: Functional and Physical Impairment assessment Advanced planning Pain screening Cognitive impairment screening Mental condition evaluation Depression risk factor Functional ability

Care Measures Special attention is paid to specific care measures such as controlling hypertension, diabetes, and hyperlipidemia.

Roadblocks Patients do not remember where and/or when services were rendered. Patients cannot afford services (deductible, copay, etc.) Inability to obtain timely reports from specialists. Inability to read the written report from a consultant.