Maximizing HEDIS Audit Automation Efficiencies with the Right Staff

Every year, Healthcare Effectiveness Data and Information Set (HEDIS) compliance audits examine the data capabilities of health plans. The goal of these audits, which include an array of quality measures, is to determine whether a health plan contains accurate and reliable data that purchasers can depend on to inform their health coverage decisions.

Preparing for the annual HEDIS audit can be a yearlong process that involves several administrative activities. It commonly requires short-term staffing to ensure an organization has enough employees during that period. In addition to early planning and management of staffing, blending in automation can streamline the process.

The Primary Benefits of HEDIS Audit Automation

HEDIS audit automation offers numerous benefits. Here are some examples:

Efficiency

Forms are one of the primary sources of patient information, but not all of them are alike. Capturing, compiling, and reporting relevant patient data can be a time-consuming effort. You can expedite this process with prefill automation, which automatically populates repeated form fields and spares you the need to perform repetitive tasks.

Increased Data Volume

Maximizing your data volume can boost HEDIS compliance by closing HEDIS gaps, which are instances of missing recommended services, particularly for preventive care. Automation helps patients and providers communicate more directly. For example, you can set up automated delivery of patient-reported outcomes and screen assessments, ensuring patients receive timely calls to action concerning their primary care experience.

Improved Data Integrity

Integrity refers to the overall completeness, consistency, and accuracy of an organization’s data. You can improve data integrity through automatic cleaning — a faster and more accurate manner of fixing or removing existing data that is incorrect, ill-formatted, duplicated, incomplete, or corrupted. Additionally, automated software can ensure real-time accuracy by checking whether information gets recorded consistently and reliably into your database.

People Still Play a Critical Role

With HEDIS, automation might shift skills and change roles, but one thing is becoming increasingly clear: People will continue to play a critical role. Think of automation as enhancing jobs and your organization’s performance. Some team members may need to acquire new technical skills to help manage technologies and ensure the right processes and tools are in place to succeed.

Identify Automated Vs. Non-automated Processes

Because not all processes can be automated, it’s important to first identify those that can be — both fully and partly. Aside from form prefilling, form delivery, and alerts, some commonly automated healthcare processes include patient scheduling and appointment reminders. These are areas that can improve patient experience, contributing to high-quality healthcare. But many of them will undoubtedly need administrative and/or clinical professionals to create, manage, and update them.

Use an Ideal Blend of People and Tools

One key tool a health plan can use is a robotic process automation program, especially if it offers features for monitoring quality protocols. Several medical record management software tools can help in cleaning up patient data and automating form delivery based on predetermined triggering events. But these tools cannot act alone. They require technical support and often require customer service support when patients encounter issues. They also require an administrative group on the receiving end, continuing to track patients’ whereabouts and help coordinate care.

Have the Right, Trained Staff in Place

The effectiveness of any tool depends on its users. To maximize your organization’s success with HEDIS audit compliance automation, search for talent — including coders, RN case managers, UR nurses, quality reviewers, care coordinators, and non-clinical staff — capable of using your automation tools to their fullest potential. Consider training your employees to provide them with essential skills and knowledge related to automation.

You may also benefit from educating staff about the accessibility of automation tools, dispelling notions about their difficulty and promoting buy-in within the organization. After the training, an ongoing evaluation of competencies can help you identify areas of improvement in your automation strategy while ensuring that staff members regularly expand their expertise.

Here at Medix, we have over 20 years of experience as a staffing partner for healthcare organizations. We can help you streamline preparations for your next HEDIS audit with skilled technology-savvy clinicians, coders, and non-clinical professionals. Our team finds the top talent for you from a pool of 3M+ candidates nationwide. In the past five years alone, we’ve deployed more than 700 skilled professionals, including RN case managers, UR nurses, quality reviewers, and care coordinators, supporting HEDIS-related functions. Contact us today to get started.