Author: Tanea Young
Introduction
As many know, 2020 was an industry-changing year due to Covid-19. Many of the changes altered healthcare delivery in a very significant way. While the barriers to providing traditional care were a boon to innovation for offering high-quality care without face-to-face encounters, the urgent need to implement workflow changes created chaos for many providers and systems.
How did we get here?
In 2019 and early 2020 telehealth applications and remote patient care products were readily available. Still, adoption was slow, and resistance was high until it became clear that change was no longer optional.
In March of 2020, Health systems realized that healthcare appointments that did not require an in-person appointment had to transition to remote encounters while still being able to offer high-quality care using technology and do so without impacting patient outcomes, maintaining the same level of patient satisfaction and in the middle of one of the most chaotic times in our recent healthcare history, remembering to close the gaps in care required to meet the quality standards. This was a tall order for the healthcare community, which had to manage more administrative burdens than ever before. For payors had to get the data on time for audits, the chaos was another barrier to accessing audit data.
How will healthcare delivery changes and challenges impact quality reporting?
While it’s clear that the challenges of 2020 created an opportunity to force the adoption of telehealth and remote patient management, what is less clear is how this rapid pivot of the care model will be measured for audits for payors. In 2022 the audits for healthcare that were provided in 2020 will be due, and the data that needs to be collected to meet quality measures will be more complicated than ever.
How will payors manage the data to ensure they avoid penalties for audits? As an example, let’s look at HEDIS. Even in a challenging year, payors still need to strive for high scores for HEDIS. A 3-4 or rarely achieved 5-star rating helps payors when employers start planning and selecting health plan coverage for the calendar year.
While it’s hard to say how quality reporting for 2020 will land, planning for the next cycle should happen now.
How will you get ready for the next year’s scores?
4 steps to raise your scores and compete in the competitive Payor market.
- Rapid access to medical records is the key that unlocks the data needed to satisfy quality metrics.
- Proactive care gap closures – ensure patients are aware of the tests, such as A1c and foot exams for diabetes, that are required but often overlooked.
- Population health management and patient engagement are essential to reminding patients about the preventive care covered and why it matters.
- Provider engagement – Partner with providers to adopt technology that takes the pressure off the clinical staff to meet the measures. Release of information vendors can make the medical record available without creating burdens on already busy clinical staff. Value-based Care Dashboards can eliminate the need to search through EMRs to find gaps in care and provide seamless access to the reporting required to prove quality measures are met and using tools such as Remote Patient Management for enhanced condition management to provide the proactive care that improves outcomes for the entire population.
How can Sharecare help:
Sharecare provider solutions offer proven solutions for medical record access. We have been in the ROI business for over 30 years and have access to over 82K provider customers and their EMRs. Payors don’t need to rely on manual chart retrieval when the data can be removed via the EMR, enabling rapid delivery of medical records. Removing the burden of providing medical records from the provider is the most efficient way to meet your audit deadlines, empower you to submit the exact data requested, and ensure less abrasion between providers and payors.
Sharecare’s Value-based care provides a dashboard view of all patients, focusing on easy access to closing gaps of care. The aggregation of all healthcare results, reminders for staff, and directly to patients enables bi-directional management for closing gaps of care and makes quality reporting for MIPS and Medicare’s Quality Payment Program.
Remote Patient Management is another Sharecare solution that supports providers providing high-quality remote care, with reminders and information to support condition management for diabetes and cardiovascular care and integrated digital prescriptions.
Sharecare’s payment integrity solutions help payors audit claims using an AI engine to examine patterns and trends in medical claims to detect fraud, waste, and abuse.
Healthcare encounters being virtual and remote care is here to stay, patients and providers prefer many aspects of remote care, and as long as the quality measures indicate the same quality of care is provided, this will be the model for today and the future. Payors who navigate this year with a solid plan will be ahead of the game in future audits to come.
In addition to HEDIS, Sharecare supports these audits:
HEDIS, RADV, Commercial, Medicare Advantage and ACA Risk Adjustment (CRA, MRA, ACA), Center for Medicare and Medicaid Services (CMA) and DRG
What to learn more?
About the author
Tanea Young is the VP Client Success-Payor Program at Sharecare Provider Solutions and is an expert in Healthcare Audits and HEDIS. She has led teams to audit success at Anthem, Optum and United Health Group.