Supporting HEDIS® Reporting 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. Capture your EHR data once and use our software 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.
  • 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. This allows data to be collected once and reported to multiple entities including CMS and the health plans.

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 eCQM testing and development.

Medisolv supports HEDIS reporting by providing 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.

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

The National Committee for Quality Assurance (NCQA) eCQM crosswalk identifies eCQMs that are tested under the NCQA Electronic Clinical Quality Measure (eCQM) Certification program, accepted in the NCQA Patient Centered Medical Home Recognition Program, as well as those selected as core America’s Health Insurance Plans (AHIP)/CMS eCQMs and used within NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) reporting.” – eCQI resource center

 

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.

 

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

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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