HEDIS Quality Reporting for Health Plans

Many healthcare plans are required to use the Healthcare Effectiveness Data and Information Set (HEDIS®) to measure and report their performance on quality of care for their covered populations. But managing the HEDIS lifecycle is a complicated process — and often a difficult one.

web2pro Risk Manager™ Compliance Reporter can help you streamline your annual HEDIS reporting and quality measurement and reporting activities, and support year-round compliance efforts. Based upon our National Committee for Quality Assurance (NCQA) certified HEDIS quality rules processing engine, web2pro's solution helps simplify the complete HEDIS hybrid review process — from the generation of samples and management of the medical record abstraction process to the creation of NCQA and Centers for Medicare and Medicaid Services (CMS) data submission files.

Compliance Reporter allows you to easily create the sample frame for Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey measures, sample your membership for HEDIS hybrid metrics and generate the NCQA Interactive Data Submission System (IDSS) file and Medicare patient-level data for final submission.

web2pro Risk Manager Compliance Reporter can help your health plan:

  • Certify final hybrid rates within minutes – not days or weeks
  • Collect data both online and offline for medical record review
  • Validate full compliance and exclusion reports
  • Configure task assignment workflows manually or systematically
  • Simplify the complete HEDIS reporting and workflow process
web2pro Risk Manager and Compliance Reporter work together for HEDIS reporting
Figure 1: web2pro Risk Manager and Compliance Reporter work together

Comprehensive Data Repository for Data Integrity

Compliance Reporter allows online and offline data collection to support medical record review activities. Claims, membership, enrollments and lab and pharmacy data are imported into a central data repository, along with scanned medical record details. This repository is updated during HEDIS season with the latest compliance details.

Streamline the Chart Review Process

With web-based medical record review and a centralized, single source of clean data, you can manage the complete process of medical record review for HEDIS. Flexible task assignment workflows allow you to allocate chart reviews manually or systematically by location. You can use powerful audit tools to generate samples of completed charts for review, as well as measure-level and member-level detail for further research.

A productivity summary for the HEDIS process helps your organization stay on track. It includes status of measures, number of charts remaining and completed by each reviewer, and a summary of members with charts. Tools for external reviewers generate full compliance and exclusion reports for validation of medical records.

Comprehensive NCQA-Certified Reporting

Compliance Reporter provides in-line rate calculation, so you can have the latest results in minutes. Live reports contain NCQA-certified results for HEDIS measures, and you can generate NCQA IDSS data files for final HEDIS reports and the CMS-required patient-level data (PLD) submission file.

Compliance Reporter supports the full suite of NCQA HEDIS quality measures and updates them annually. When used with web2pro Risk Manager, the solution's built-in reports help you review performance of your plan as well as individual provider groups or physicians. Graphical displays illustrate compliance, performance detail by product line and by plan, and overall measure performance.

Pairing Compliance Reporter with web2pro Risk Manager supports the full quality management lifecycle. Together, they provide the robust reporting and measurement capabilities you need to be successful, including the calculation of financial rewards for quality and other pay-for-performance (P4P) metrics.

web2pro Risk Manager Compliance Reporter features:

  • Productivity summaries for all measures, reviewers and members
  • Management chart review and chart chase management
  • A centralized, web-based data repository
  • No software installation or maintenance (hosted solution)
  • NCQA-certified HEDIS measures, including generation of NCQA IDSS and CMS PLD submission files

Want more information?
Let web2pro be the cornerstone of your clinical integration program. We'll help you find the right tools. Call 781.290.2500 or request more information.