Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Using HEDIS Measures to Improve Health Plan Star Ratings

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Sponsored by: Change Healthcare

The Healthcare Effectiveness Data and Information Set (HEDIS) provides a detailed view of the healthcare services provided to health plan beneficiaries and whether those services improve patient health. About 90 percent of health plans use these measures to offer a side by side comparison of health plans.

Health plans have a strong incentive to perform well on these star ratings. Commercial, Medicare, and Medicaid plans use HEDIS scores to create consumer-facing star ratings, which in turn can influence whether an individual enrolls on a certain health plan.

Learning Objectives:

• Understand how HEDIS measures relate to star ratings

• Identify organization-specific HEDIS improvement areas as they relate to star ratings

• Share proven strategies targeting key improvement areas

• Develop an action plan for new organizational initiatives directed at HEDIS measure and star rating improvements

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