HEDIS Time: Annual Medical Records Review
| Date: | February 1, 2017 |
| To: | Health Plan of San Joaquin (HPSJ) Providers and Practitioners |
| From: | Medical Management Department – Health Plan of San Joaquin |
| Subject: | HEDIS Time: Annual Medical Records Review |
| Business: | Medi-Cal, MCAP (Medi-Cal Access Program, previously known as AIM) |
Traditionally scheduled for February through May of each year, the 2017 Medical Review Process will begin tomorrow, February 2.
What is HEDIS? – A Recap
The Healthcare Effectiveness Data and Information Set (HEDIS) is the most widely used array of performance measures in the United States health care delivery system. HEDIS was developed and is maintained by the National Committee for Quality Assurance (NCQA). The performance measures in HEDIS are related to many significant public health issues such as cancer, heart disease, smoking and diabetes. The State of California Department of Health Care Services (DHCS) uses the HEDIS measures to evaluate health issues and health plan performance.
The 2017 Medical Records Review
During the coming weeks, HPSJ will work with our contracted providers to review encounter and claims data from the prior year and conducts medical record reviews to survey “how well your practice” completes certain services.
The HEDIS-related services include:
- well child visits
- immunizations
- timely prenatal and postpartum visits
- diabetic care
- controlling high blood pressure
- cervical cancer screenings
- adult BMI
- weight assessment/counseling
Additionally, we will include a DHCS-required service for medical record review – Initial Health Assessment/Staying Healthy Assessment
HEDIS measures allow HPSJ to gauge quality and effectiveness of care. Importantly, they also enable HPSJ to reward our providers for their efforts through our incentive program.
We thank you for your continued partnership in delivering the highest quality of preventive and effective care for our members who are your patients.
If you have any further questions, please contact our Provider Services Department at 209- 942-6340.