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Resumen de proveedores | Número 17

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Medical Record Request for HEDIS Measurement Year (MY) 2022

The annual Healthcare Effectiveness Data and Information Set (HEDIS®) project is underway! California’s Department of Health Care Services (DHCS) requires health plans to collect and report HEDIS data annually.

As an Alliance provider, you have agreed to cooperate with our quality and audit programs, including providing medical records where needed. We thank you in advance for participating!

  • The request: Please have your office be on the lookout for a patient medical record request from our vendor, KDJ Associates, Inc., between February and May 2023.
  • Data collection methods: Include fax, mail, on-site visits and remote electronic medical record (EMR) system access.
  • Timeline: Providers should submit requested documentation within five days.

Which measures are being reviewed?

The following HEDIS® measures will be reviewed this year:

  • Estado de vacunación infantil.
  • Vacunas para Adolescentes.
  • Detección de cáncer de cuello uterino.
  • Atención prenatal y posparto.
  • Controlar la presión arterial alta.
  • Atención Integral de la Diabetes.
  • Lead Screening in Children.

What do we do with the data?

We use this data to develop and enhance educational programs and member/provider benefits, and to monitor:

  • Calidad de la atención brindada.
  • Tarifa a la que los afiliados acceden a los servicios preventivos.
  • Indicadores que describen qué tan bien los miembros están manejando las condiciones crónicas.
  • Desempeño del proveedor.
  • Desempeño del plan de salud.

Questions

Find answers to frequently asked questions in the Guía de preguntas frecuentes de HEDIS.

You can also contact Georgia Gordon, Alliance Quality Improvement Project Specialist, at 209-381-7391 or [email protected].

Increase colorectal cancer screening rates at your office

Colorectal cancer screening is an exploratory measure in the 2023 Care-Based Incentive program. In preparation for Colorectal Cancer Awareness Month in March, here are three ways to increase screening rates to improve measure performance.

Identify patients due

  • Ejecute informes de gestión de la salud de la población desde su EHR, incluidos los miembros activos e inactivos u otro filtro con límite de tiempo. Muchas prácticas mantienen a los pacientes inactivos después de 18, 24 o 36 meses, lo que puede hacer que los pacientes no se realicen la prueba de detección de cáncer colorrectal.
  • Desarrolle indicaciones o indicadores que aparezcan para alertar a los equipos de atención sobre cuándo los miembros deben someterse a exámenes de salud preventivos durante la preparación del historial médico o cuando un miembro se presenta en su centro de salud.

Outreach for patient engagement

  • Designar a un miembro del equipo de atención para que se comunique con los pacientes que deben someterse a pruebas de detección de cáncer colorrectal.
  • Send targeted mailings, text messages or emails and follow up with telephone calls to chronically noncompliant patients. Studies have shown that the best way to reach patients is by combining a variety of methods, so don’t stop with the reminder postcard. Pick up the phone or send a text.
  • Promote test choice. Studies have shown that when provided with options, many patients choose stool-based testing over colonoscopy for colorectal cancer screening, and are more likely to adhere to regular screening when they have a choice of tests.

Create an inclusive culture

  • Offer extended hours on weekends and evenings.
  • Contratar médicos que se adapten a las necesidades lingüísticas, las preferencias de género y la sensibilidad LGBT de los pacientes atendidos.
  • Encourage continuing medical education (CME) for providers that support culturally competent screening, education and diagnosis screening follow up per national guidelines.
  • Cultural competence is not just limited to race, ethnicity and culture. Perceptions, values, beliefs and trust can also be influenced by factors such as religion, age, sexual orientation, gender identity and socioeconomic status.

Para obtener más información, consulte la Detección del cáncer colorrectal: hoja de consejos sobre medidas exploratorias.