Maximizing Your Quality Improvement Initiatives with Prospective Data Runs

Maximizing Your Quality Improvement Initiatives with Prospective Data Runs

What does the future hold for HEDIS® and your HEDIS results? No one can know for sure, but for quality improvement initiatives, prospective monthly runs can give you better insight and help you stay on top of results.

With monthly prospective data runs, health plans can monitor how each HEDIS measure and sub-measure is tracking towards a specific goal. Additionally, plans can conduct rolling 12-month reviews to track the status of year-to-date results (e.g., April 2019 to April 2020) to identify actual due dates of specific services to optimally focus outreach efforts.

Three Reasons Why High-Performing Plans Complete Prospective Runs

  1. Track trending towards goals, benchmarks, and/or last year’s submission results. NCQA’s new timeline for releasing HEDIS specifications allows plans to start improvement efforts and react sooner to new measures and measure changes.
  2. Create an off-season chart review project. During the project, medical record data can be collected for your HEDIS hybrid measures. In addition, we have a few administrative measure data collection forms that can be used to collect medical record data as well. This data is collected and then included with next season’s administrative data sources, reducing abstraction collection during the HEDIS season and maximizing administrative rates.
  3. Set targeted member and provider outreach efforts. With prospective monthly data runs, the most current gap lists can be sent to providers or used to coordinate with members to close gaps quickly to impact measurement year HEDIS rates.

To learn more about how prospective monthly data runs can benefit your quality improvement initiatives, email us or call 877.896.7350.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).