Why It's Crucial to Have a Vendor with No HEDIS® Recertifications

Accurate, complete HEDIS^® data collection, measurement, and reporting are critical for health plans to generate client trust, create positive results, and improve quality. NCQA aids plans in selecting their data partners by auditing collection logic based on their information systems capabilities and HEDIS specifications. 

When a vendor is certified it ensures that the vendor has complied with these standards and tells health plans they can confidently use the vendor’s platform as its compliance mechanism.

Time-Tested Reliability

Only a select few vendors achieve certification and doing so for consecutive years demonstrates a commitment to service and our consistent updates to the software to meet ever-changing HEDIS regulations. Your vendor's approach should align care management with other plan objectives, such as:

• Provider Communication
• Risk Adjustment
• Member Engagement

This integration enables year-round care gap closure.

On the other hand, newly-certified vendors lack a firm, long-term grasp of the regulations. Health plans should be wary of committing to a platform and methodology that may not be able to maintain certification or adjust to new regulatory requirements and measurements year by year.

Zero Recertifications

It's not easy to maintain uninterrupted certification year after year and you should always go with a partner that hasn't had to recertify any measures. This shows payers that their HEDIS management and submission solution is reliable for driving improved treatment outcomes and revenues. NCQA requires certified vendors to recertify whenever it finds lapses in the integrity of the software code. These flaws can prove significant, especially if they occur in widely reported categories such as well-child visits or antibiotic utilization. Partnering with a vendor that is required to recertify can throw a health plan into disarray. The plan will be forced to make unforeseen – and unbudgeted – corrections to its data collection and reporting process.

Year-Round Gap Management

Vital Data Technology helps payers segment populations to better target members and physicians. This stimulates communication with physicians groups and patients to create care management reminders so health plans can close gaps throughout the year, not only during the reporting period. Our platform streamlines and expedites HEDIS reporting and submissions, automating time-consuming and labor-intensive medical record retrieval so care providers can schedule often-overlooked healthcare visits:

• Well-child
• Prenatal
• Advance Care Planning
• Age-based vaccinations
• Diabetes, high blood pressure, and cholesterol management
• Prescription Management 

With the COVID pandemic still looming in our lives, it's more important than ever for health plans to maintain stability in a time of chaos - and that starts with reliable HEDIS management.