Standardize, compare, optimize, report and enhance your HEDIS capability in near real-time environment

In the age of value based healthcare and reimbursement, health plans face increasing pressure to improve their bottom-line in an uncertain environment. As a result, regulatory incentives such as CMS Star ratings, and underlying HEDIS performance, have a new meaning.

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With stringent audit timelines and complex data collection processes, health plans need to aggregate and manage multiple types of data (e.g. claims data, clinical data, supplemental data) from a wide spectrum of stakeholders across the care continuum. Frequent generation of HEDIS reports can enable health plans to improve compliance, engage providers, and close gaps in real-time.

 

SCORE+ for HEDIS is an end-to-end HEDIS performance management suite to help healthcare organizations accelerate quality reporting and enhance collaboration for gap closure to drive HEDIS performance. The solution is based on CitiusTech’s NCQA certified BI/analytics platform, BI-Clinical, which provides 750+ pre-built KPIs across a wide range of quality reporting needs. With a comprehensive set of NCQA mandated validations as well as enhanced reports, SCORE+ for HEDIS enables health plans to generate HEDIS reports faster than almost every other HEDIS reporting application in the market.

 

Achieve Daily Runs for HEDIS Submission

BI-Clinical has a high performance rules-engine that enables organizations to carry out daily prospective HEDIS compliance runs, reduce turnaround time & accelerate gap closure.

  • NCQA Compliant Validations & Reports: CitiusTech’s BI-Clinical platform is NCQA certified for 2018 HEDIS® hybrid measures and systematic sampling and is currently pursuing NCQA certification for all HEDIS 2018 measures. All relevant functional modules such as the clinical/ chart data collection & audit reporting functionalities fully comply with NCQA requirements.
  • Simplified yet comprehensive Rules Management: BI-Clinical offers a highly configurable rules engine, support for real time clinical alerts and data models like UDMH, OMOP, FHIM. It includes a seamlessly integrated Rules Management Module to provide clients / end users an easy to use, DIY interface to author, version, audit, test & manage both standard HEDIS measure definitions as well as custom measure versions.
  • Custom Measures: The Rules Management Module allows users to define, modify, test and manage custom measures, over and above the existing library of pre-configured HEDIS measures. Health plans have the flexibility to enable self-service configuration without needing to rely on external teams.

 

  • Accelerated Measure Updates & Frequent Runs: With high-performance data architecture, BI-Clinical enables health plans to carry out multiple prospective HEDIS compliance runs every month. The highly flexible and configurable Rules Management Module allows you to roll out new HEDIS measures within 60 days post release from NCQA.
  • Chart Abstraction: Mobile-ready and configurable workflow-driven module for suplemental data collection. Supports onsite as well as remote chart retrieval and abstraction from provider partners. Seamless integration with provider portals or existing document management systems. Optional accelerators to ingest, process & use HL7, CCDA messages as well as data quality accelerators.
  • Analytics & Reporting: Powerful features to integrate evidence-based information with the care delivery process. Integrates with multiple healthcare applications, provides a single view of analytics, and enables decision making for providers and clinicians at the point of care. Helps organizations avoid errors, improve member engagement and identify potential gaps-in-care.

 

HEDIS Case Study                                  

 

Quality Management and Reporting for Leading Payer

Learn how a leading payer is leveraging BI-Clinical for a near real-time quality and custom reporting for HEDIS measures