Provider Digest | Issue 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:

  • Childhood Immunization Status.
  • Immunizations for Adolescents.
  • Cervical Cancer Screening.
  • Prenatal and Postpartum Care.
  • Controlling High Blood Pressure.
  • Comprehensive Diabetes Care.
  • 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:

  • Quality of care delivered.
  • Rate at which members access preventive services.
  • Indicators that describe how well members are managing chronic conditions.
  • Provider performance.
  • Health plan performance.


Find answers to frequently asked questions in the HEDIS FAQ Guide.

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

  • Run population health management reports out of your EHR, including either active and inactive members or another time-bound filter. Many practices make patients inactive after 18, 24 or 36 months, which may miss patients due for their colorectal cancer screening.
  • Develop prompts or flags that pop up to alert care teams for when members are due for preventative health screenings during chart prep or when a member presents in your health center.

Outreach for patient engagement

  • Designate a care team member to outreach to patients due for colorectal cancer screening.
  • 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.
  • Hire clinicians to accommodate language needs, gender preference and LGBT sensitivity of patients served.
  • 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.

For more information, see the Colorectal Cancer Screening – Exploratory Measure Tip Sheet.