HEDIS Reporting Solution for Provider Practices

Medisolv’s award winning Quality Management Platform now supports HEDIS reporting for provider practices in addition to QPP/MIPS and ACO reporting.

Provider benefits include:

  • Reduce reporting burden. We capture your EHR data once and report to multiple entities including CMS, health plans and state agencies.
  • Monitor performance throughout the year and take corrective action for gaps in care.
  • Measures selection provided with our tools.
  • Negotiate with payers using your performance data and reported patient data.
  • Easily load lists of patients provided by payers.
  • No need for supplemental data audits when payers use data submitted by Medisolv.
  • Consultants assist in data quality improvement using our software tools. You can be confident in the accuracy of your results.
  • Regulatory guidance included by experts.
  • Specifications regularly updated in the Medisolv software.

What you should know about HEDIS

What are HEDIS measures?

Health plans report data on quality measures developed by NCQA as part of the Healthcare Effectiveness Data and Information Set (HEDIS). Traditionally these measures are generated either through claims data or a combination of claims and clinical data in the “hybrid” methodology. Clinical data collected for these measures is often obtained from provider practices and is subject to an audit for primary source verification. This is very expensive and time consuming for both health plans and providers. Data collected in electronic health records could provide a ready source for calculation engines designed to match data with standardized electronic specifications to generate measure results in a completely automated digital framework.

How are these measures reported?

NCQA has embraced a Digital Quality Measures framework for the future of HEDIS measures reporting by health plans as Electronic Clinical Data Systems (ECDS). Many of these measures use the same clinical logic as Electronic Clinical Quality Measures (eCQMs) used for provider reporting to CMS programs including QPP/MIPS. Systems certified by the NCQA for these eCQMs are able to report these data to a health plan for their members electronically. This allows data to be collected once and reported to multiple entities including CMS and the health plans. Furthermore, data submitted through this mechanism is exempt from audits for primary source verification thus reducing cost and reporting burden.

Why Medisolv?

As the leading healthcare quality data management company, Medisolv has been solely focused on electronic quality measurement long before other companies came into the space. In fact, ONC and NCQA have used Medisolv for some of their HEDIS eCQM testing and development.

As your partner in HEDIS reporting, Medisolv provides provider practices with award-winning support, comprehensive services and leading technology. Our quality management suite compiles, organizes and simplifies your healthcare quality data. We provide insights into your patients and fundamentally help health plans improve their HEDIS ratings performance.

Medisolv is currently undergoing NCQA certification for eCQMs listed in the chart below, which also includes a cross walk for HEDIS hybrid measures.

See our software in action

Ready to see a demo of our HEDIS Reporting software solution? We're happy to schedule a one-on-one meeting with you.

NCQA eCQM / HEDIS Cross Walk List

CMS Measure
Measure Name
Applicable HEDIS Measure
CMS122*
Diabetes: HbA1c Control
CDC-HbA1c testing, >9%, <8%, <7%
CMS165*
Controlling High Blood Pressure
CBP, CDC-BP
CMS117
Childhood Immunization Status
CIS
CMS124
Cervical Cancer Screening
CCS
CMS125
Breast Cancer Screening
BCS (ECDS**)
CMS130
Colorectal Cancer Screening
COL (ECDS**)
CMS69
Preventive Care and Screening: BMI Screening and Follow-Up Plan
ABA
CMS155
Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents
WCC
CMS2
Preventive Care and Screening: Screening for Depression and Follow-Up Plan
DSF (ECDS**)
CMS127
Pneumococcal Vaccination
AIS (ECDS**)
CMS134
Diabetes: Nephropathy Screening
CDC-nephropathy
CMS147*
Preventive Care and Screening: Influenza Immunization
CIS-influenza, Combo 6, Combo 8, Combo 9 and Combo-10, AIS (ECDS**)
CMS153
Chlamydia Screening
CHL
CMS131
Diabetes: Eye Exam
CDC-eye exam
CMS146
Appropriate Testing for Children with Pharyngitis
CWP
CMS137
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment
IET
CMS156
Use of High-risk Medications in the Elderly
DAE, DDE
CMS144
Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)
PBH
CMS145
Coronary Artery Disease (CAD): Beta-Blocker Therapy-Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVSD)
PBH
CMS128
Antidepressant Medication Management
AMM
CMS159
Depression Remission at 12 Months
DRR (ECDS**)
CMS82
Maternal Depression Screening
PDS (ECDS**)
CMS136
Follow-Up Care for Children Prescribed ADHD Medication
ADD
CMS154
Appropriate Treatment for Children with Upper Respiratory Infection
URI
CMS160
Depression Utilization of the PHQ-9 Tool
DMS (ECDS**)
CMS347
Statin Therapy for the Prevention and Treatment of Cardiovascular Disease
SPC, SPD
CMS68*
Documentation of current Medications in the Medical Record
MRP
CMS139
Screening for future Fall Risk
FRM

* eCQM specification is partially aligned with traditional HEDIS measure specification.
** Medisolv product supports ECDS specifications at the Health Plan Level.

NOTE: This list is valid through Performance Year January 1 through December 31, 2020 and is subject to change in future as needed.

For HEDIS 2020, NCQA-certified eCQM vendors can transform certified QRDA1 files to other industry standard formats (e.g., CCD, FHIR) so the data can be ingested for HEDIS reporting. The transformed file (e.g., CCD, FHIR) must include only data from the certified QRDA1 file. Auditors must validate the transformed file to the certified QRDA1 file, verifying nothing changed in the transformation process. If validation passes, the transformed file can continue to be considered standard supplemental data.

Key Components

Robust CQM Product

  • Our CQM engine supports large volumes of patient data and thousands of users.
  • We stay on top of the latest specifications and all versions of eCQMs are available in the product.
  • New specifications are available in the product every January of the reporting year giving time for practices to measure and improve performance throughout the year and not just at the end.

Submission Services

  • Full submission services using QRDA 1 files are provided.
  • Files for reporting in custom formats can also be created, when feasible for an additional fee.
  • Supports HEDIS audits. 

Consultation Services

  • Each client receives a comprehensive, hands-on implementation
  • Each year as the specifications are updated, we provide education around the updates and measure improvement support.
  • We provide regulatory compliance guidance.
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