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

Managing HEDIS quality performance can be tricky, with stringent audit timelines and diverse data needs. Health plans and PSPs need to sift through a lot of data (e.g. claims data, clinical data, supplemental data) to identify gaps and chase them to closure efficiently. They also need to drive process efficiencies and take meaningful steps to minimize provider abrasion.

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SCORE+ is an end-to-end HEDIS performance management suite to help organizations accelerate quality reporting,  enhance collaboration for gap closure, minimize provider abrasion and  improve HEDIS performance. The solution is based on CitiusTech’s NCQA certified BI / analytics platform, BI-Clinical, which has 700+ pre-built KPIs across a wide range of quality reporting needs. 

 

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 all 2020 HEDIS® measures. All relevant functional modules such as the clinical / chart data collection and 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 and 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 a high-performance data architecture, SCORE+ enables health plans to carry out multiple prospective HEDIS compliance runs every month. The Rules Management Module allows you to roll out new HEDIS measures within 60 days post release from NCQA.
  • Clinical Data Abstractor: Intuitive suggestions to improve operational efficiency and increase scores using Natural Language Processing (NLP) models. This includes auto-identification of hidden opportunities for care / risk improvement by examining every chart against open gaps, easy identification of data in charts to speed up chart abstraction, and dashboards to track gap closure, HCC code captured, accuracy of NLP model.
  • 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