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

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

3. 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.

4. 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.

5. 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!

6. 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.

7. 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)

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

9. 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)

10. 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

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

12. 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.