Acronym/Vocab
What does HEDIS stand for?
Healthcare Effectiveness Data and Information Set
Which of the following is a care gap?
A) A completed colorectal screening
B) An overdue blood pressure check
C) A timely vaccination
D) A scheduled dental appointment
Answer: B
An overdue blood pressure check
HEDIS performance is measured by using data collected from what following sources? If you could name one of three sources?
•Administrative Data: Comes from Facets (like a member’s claims for receiving preventative services). Some state registries and electronic medical records can also contribute data.
•Hybrid Data: This data is obtained from medical record reviews and is based on a random sample of the population.
•Survey Data: This is obtained from member surveys that evaluates health plan and provider performance.
When does the HEDIS database updates its information?
Every 30 days/Every Month
What source is NOT used to measure HEDIS performance?
A) Administrative Data
B) Hybrid Data
C) Financial Data
D) Survey Data
Answer. C Financial Data
What does the acronym (NCQA) stand for?
National Committee for Quality Assurance
What is the primary purpose of HEDIS?
A) To reduce healthcare costs
B) To inform members of their health status
C) To measure the clinical quality performance of health plans
D) To monitor insurance fraud
Answer. C
To measure the clinical quality performance of health plans
The HEDIS program at HAP assists in facilitating primary care appointments. It educates the members on the importance of completing the following preventative and/or disease management services.
Can you name one preventative HEDIS measure that falls under the category Children?
Childhood Immunization (CIS)
Adolescent Immunizations (IMA)
Well-Child Visits in the First 30 Months of Life (W30)
Children and Adolescent Well-Care Visit (WCV)
Lead Screening in Children (LSC)
True or False: The HEDIS Look-Up Database allows CSS to check a member’s record.
True
True or False. Customer Service Specialist does not need to document this call in Pega? If so, under what intent is launched?
False. GSR
Recommended preventative and/or disease management services that are pending in the members’ health plan records.
How many HEDIS measures are there?
B. 90
Can you name one preventative and/or disease management services found under the"Women" category?
Cervical Cancer Screening (CCS)
Postpartum Care (PPC)
Breast Cancer Screening (BCS)
Osteoporosis Management in Women who had a Fracture (OMW)
True or False: The HEDIS program only works with children and adolescents.
False
During a call with an existing HAP member, a CSS identifies and communicates any open care gaps to the member. There may be cases when members do not have any gaps in care.
What does the CSS do next?
Nothing - The CSS continues with helping member.
In such a case, the CSS's screen would state the following message.
"There are no gaps available for this member."
What does the acronym CSS stand for?
Customer Service Specialist
True or False: A care gap occurs when a recommended service has not been completed on time.
Answer: True
Can you name one preventative and/or disease management services found under the"Adults" category?
Colorectal Cancer Screening (COL
Controlling High Blood Pressure (CBP
Diabetes Care - Retinal Eye Exam
Diabetes Care - Kidney Screening
Diabetes Care - HbA1c Testing
Activity for student: Student will show the class where to find HEDIS information (not the Sportal).
Student will need to share screen and show us how they navigated to HEDIS.
1.Use the https://onehap.sharepoint.com/ link to open the OneHap screen.
2.Click the Quick Links drop-down list.
3.Select HAP.org - Employee Portal.
What does a CSR mention in the Comments field when closing an open care gap?
Must document details of the call and the actions that were taken.
What does the acronym LSC stand for.
Lead Screening in Children (LSC)
True or False: Members generally understand the term "Care Gaps" without explanation.
Answer. False
Can you name two strategies used by HAP to close care gaps:
Offering members the opportunity to close the gap with their providers or with HAP-partnered vendors
Reviewing care gaps with members during phone interactions and other member outreach
What are two scenarios that could result while in the HEDIS lookup database?
1. Open Care Gaps
2. No Open Care Gaps
True or False. If members have open care gaps, the CSS must inform the member about each open gap individually and document these conversations using a GSR.
True.