HEDIS and Outreach
Disease Management is not dead… Contrary to some
beliefs. Disease management companies
will be back stronger than ever. Why do you ask? Simply HEDIS performance
improvement. In order to show
improvement you need to reach members to get those screenings, tests, and
medication persistence. A lot of
companies ditched their DM vendors and in sourced their services as a way to
save money and still keep their NCQA accreditation. In the short term it made sense. There wasn’t
much “value” in just keeping a company
around for QI8. What a lot of plans
don’t realize is that DM vendors provide tremendous value in moving HEDIS
scores. They have the knowledge, infrastructure and programs already in place
to touch those critical HEDIS concerns.
To be totally frank the NCQA DM program is basically a blue print on how
to improve HEDIS scores. Here’s a little tidbit NCQA DM Performance
measurements is linked to HEDIS, there a reason why they did this. Think about it…. More on this later
Good premise. The old model of purely telephonic DM, disconnected from the providers practice might be able to gather stats and provide a sentinal effect but doesn't show as much behavioral change as those same practices coming from the provider or his clinical staff. The model needs to change.
ReplyDeleteThanks Michael for the feedback!
ReplyDelete