Healthcare Effectiveness Data and Information Set (HEDIS)
SCCP supports the work of health plans to improve their HEDIS scores by closing member care gaps for the following HEDIS measures:
Prevention and Screening
-
-
- Breast Cancer Screening (BCS)
- Cervical Cancer Screening (CCS)
- Colorectal Cancer Screening (COL)
-
Behavioral Health
-
-
- Follow-Up After Hospitalization (FUH)
- Follow-Up After Emergency Department Visit for Mental Health (FUM)
- Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence (FUA)
-
Medication Management and Care Coordination
-
-
- Follow-Up After Emergency Department Visit for People With Multiple High-Risk Chronic Conditions (FMC)
-
Access/Availability
-
-
- Adults’ Access to Preventive/Ambulatory Health Services (AAP)
- Annual Dental Visit (ADV)
- Prenatal and Postpartum Care (PPC)
-
Utilization
-
-
- Child and Adolescent Well-Care Visits (W30, WCV)
-
We employ the following strategies to close HEDIS care gaps:
-
- Reducing engagement fragmentation by creating a single touch point for HEDIS compliance outreach.
- Providing coordinated HEDIS Compliance Support to members:
-
-
-
- Scheduling HEDIS gap closure appointments (wellness visits, lab work, health screenings, etc.).
- Appointment reminder calls.
- Post appointment follow-up to ensure compliance.
- Addressing barriers to HEDIS compliance (i.e., transportation).
- Addressing member health literacy through education.
- Addressing exclusions.
- Making social service referral where necessary to support gap closure.
-
-
-
- Encouraging at-home testing where available.
- Using a multichannel approach to member engagement (phones, texting).
- Offering clinical support (NPs under the supervision of a Medical Director) to close Gaps:
-
- Ordering lab tests where needed.
- Clinical engagement (wellness exams and other examinations) via onsite, telehealth, or home visits.
-
- Sharing reports through a robust data integration platform.