Skip to main content

How Important is Your HEDIS Score as a Healthcare Provider?

Both independent primary care providers (PCP) and healthcare establishments (clinic, hospital, nursing home, etc.)must pay attention to their Healthcare Effectiveness Data and Information Set (HEDIS) score. This is necessary because health insurers rely on HEDIS to both create and update their own assessments about each healthcare provider individually.

If the major healthcare insurance providers in an area decide not to include a PCP in their list for coverage, that can have a crippling effect on the excluded healthcare provider’s business. Therefore, improving the HEDIS score is indeed more important that some healthcare providers may realize.As we delve deeper into the facts, the connection should start to make even more practical sense.

Why is the HEDIS Score So Integral?

The Healthcare Effectiveness Data and Information Set score holds more importance today than it did before the value-centric healthcare insurance contracts were introduced. More commonly known as risk contracts, these focus on allocating a certain budget to each patient depending on their healthcare plan and the necessary treatment. If the healthcare provider generates a bill that exceeds the allocated budget, then they will not be reimbursed by the insurer, beyond the predefined budget.

Although it was initially introduced with the MIPPA to solve acommon issue of excess billing by PCPs and other healthcare providers, risk contracts also present a different problem. Now that the healthcare providers are put on a budget and the risk of covering for the exceeded budget lies mainly with them, there is always a high probability that the patient will not receive the quality of care that they need.

The HEDIS score counters this issue as it clearly indicates how effective the provider has been so far in treating and caring for their patients with an assurance of qualityIf a healthcare provider’s HEDIS score dips low, then they will not be covered by most insurers. Since the HEDIS score is directly related to the patient’s quality of care, it acts as a protective shield against medical negligence for the patient.

What Makes Up the HEDIS Score?

As mentioned, HEDIS stands for Healthcare Effectiveness Data and Information Set, which means that the score is created after analyzing several sets of informational data from the provider’s history of effective and ineffective patientcareThere are several key performance indicators of HEDIS such as measurements and domain, data collection, HEDIS compliance audit, ICD-10, NCQA screenings, NVQA reports, and more.

These are analyzed and compared to first create and then maintain the healthcare provider’s effectiveness over time. Note that a healthcare insurer will not just consider the medical care provider’s overall score, but they will also consider their individual scores in the different facets of effective patientcare.

What is HEDIS Accreditation?

Only a handful of the best healthcare providers meet the HEDIS accreditation standards because it requires not only reaching, but also maintaining a very high HEDIS score. Notethat adopting a risk contract is almost essential to have a HEDIS accreditationalthough adopting one does not guarantee that you will receive the accreditation by defaulteither.

Healthcare providers that do manage to meet the standards will receive joint accreditations from the nation’s highest accreditation boards for their respective fields. The National Committee for Quality Assurance (NCQA) accreditation will be common to all.


Popular posts from this blog

Copycat Boston Pizza's Bandera Bread

Have you ever had a craving for something but then once you looked at it you realized, I can make that myself for next to nothing? That's how I felt last night I thought about ordering in some food but then realized I really don't want to spend any money. I really wanted pizza bread from Boston Pizza. So I recreated it and oh my goodness was it ever good.  Don’t knock the simplicity this dish is sweet and salty and savoury all in one. The best Bandera Bread you can make is at home in your own oven, it costs Pennie’s on the dollar making it a frugal craving fixer that anyone can create!   Pizza Bread Dough 1 cup warm water 1 tsp instant yeast 1 tsp sugar 2 cups flour 1 pinch of salt  Seasoning 1 tbsp melted butter 1 tsp garlic powder 1 tsp onion salt 1 tsp parsley 1 tsp rosemary 1 tsp basil 1 tsp oregano 1/2 tsp sugar 1. Combine the water, yeast, and 1 tsp of sugar and pinch of salt in the mixing bowl and let stand for 5 minutes. Add the flour and salt

Affordable Ways To Make Your Home Look Luxurious

How do they do it? Professional designers seem to pull it off so effortlessly, but how will you make your home look more luxurious? You could just employ a professional or you can personally undertake the task of transforming your home into a place of luxury on a budget. In order to save money on your purchases, be creative and vigilant in your pursuit for the perfect style. Follow our budget-friendly ways for making your home a vision of luxury. Think it through, choose a style Luxury look isn’t enough to go on, so before you start shopping and wasting your money on furniture and decorations you might not even use in the end, first do some research. Go online and do some window shopping and find which style is more to your liking . An elegant Victorian style or something more modern and chic? Don’t get me wrong, you may want to mix and match, but before you commit by buying anything, consider what look you are going for. White is the color of elegance Choosing white as yo

DIY Table Revamp

I wanted to share a little DIY with you guys that involves duct tape! A few months ago my daughter's little chair that goes with her table she sits at every day tore and she made it worse by pulling all of the stuffing out of the seat! What started out as a quick fix turned into a great idea. She loved her seat so much that she has now decided that her table has look cool too so being the smarty pants that she is, she tore her table!