The first major attempt at measuring US health care quality was at Massachusetts Hospital in 1910. Surgeon Ernest A. Codman proposed hospitals track all patients as long as needed to see if treatment improved their conditions. While tracking patients for potentially their entire lives didn’t catch on, there are many other tools available today to assess health care quality. HEDIS, the Healthcare Effectiveness and Data Information Set, is a tool widely used for quality reporting by health care insurance organizations. Developed by the National Committee for Quality Assurance (NCQA) in the early 1990s, HEDIS data measures specific aspects of a health care insurance organization, such as effectiveness and accessibility of care, various cancer screenings, utilization, and more. Any entity that wishes to report HEDIS measures must undergo an audit by an NCQA-licensed organization, led by an NCQA-certified auditor.
A Certified HEDIS Compliance Auditor (CHCA) is needed during this process to make sure organizations adhere to the rigorous standards and protocols set forth by NCQA. MetaStar has been a licensed HEDIS audit organization since the program’s inception. In a recent interview, Patience Hoag, a HEDIS Practice Leader at MetaStar, made it clear that the only choice for a HEDIS audit organization is MetaStar.
Over 90% of health care insurance plans participate in HEDIS, according to the NCQA. “HEDIS provides transparency to purchasers and consumers by allowing direct comparison of the performance of one health plan against another,” explained Hoag. “It also illustrates the organization’s commitment to providing quality healthcare and improving outcomes.” This is complemented by the MetaStar audit team’s commitment to health care quality improvement.
MetaStar stands out from other HEDIS audit organizations by engaging early and often with its HEDIS customers. For new customers and those needing a refresher, MetaStar offers a HEDIS 101 course providing the basics of the audit process, expectations, tips, and potential pitfalls. Next, a kick-off call is held with the MetaStar HEDIS team and the organization’s HEDIS team. This allows the two teams to meet each other, go over what will be happening at a high level, and answer questions.
After the kick-off call, it is time for the HEDIS Roadmap. “The Roadmap is a comprehensive document that will inform the auditor as the season launches,” explained Hoag. The Roadmap will contain vital information for the audit, such as what kinds of data systems the organization uses, where and how frequently they get data from their sources, what kind of quality checks they have in place, who needs to be involved in the audit, and more— “all of the details about the different types of data that are used to generate HEDIS measures,” added Hoag. While the document can be intimidating, Hoag assures customers their MetaStar auditor will be there every step of the way, providing ongoing support, communicating frequently, and making sure everyone is on the same page. Hoag likes to use the word “guardrails” to describe how the auditor can help the health plan team. They can “inform and guide along the way,” she said. “We can get the health plan’s team pointed in the right direction.”
In addition to the exceptional auditing skills and personalized support, MetaStar provides robust resources for organizations that are available from an easy-to-use web portal. Via this portal, health plans have access to a tailored timeline of the audit process to “help make sure nothing gets missed and everything stays on course because there are so many moving parts,” Hoag said. Organizations can also access a report of follow-up items the auditor might ask for, and the portal also serves as a Soc2®-certified document exchange platform. Additionally, MetaStar has customer relationships and retention rates Hoag described as “fantastic,” with “a vast majority of clients who will refer us to another organization.”
Using a collaborative approach, the MetaStar HEDIS auditors come in with an open mind, and if they see a gap, they do not immediately assume the worst. “We may not have complete information, and we have dialogue to ensure the health plan is complying with requirements,” Hoag explained. “We are friendly, we are human, we are professionals, and we are here to support you.”
“Our passion at MetaStar is quality improvement, and that comes forward in everything we do, including the HEDIS audit,” Hoag said. When a MetaStar auditor offers a recommendation during the HEDIS audit, it sets off a chain reaction of quality improvement. The health plan implements the recommendation, resulting in a smoother audit process and high-quality data submission to NCQA. This allows the health plan to clearly identify areas of success and opportunities for improvement, ultimately enhancing the quality of the plan itself and the care its members receive.
As a nonprofit organization, MetaStar’s mission goes beyond making money. The goal is to improve the quality of health care in Wisconsin and beyond. The HEDIS audit is one of the many multi-faceted programs that help meet that ambitious goal. “The approach we use at MetaStar is truly unique,” said Hoag. “And that’s the heart of the company.”
If your health care insurance organization needs a HEDIS auditor with extensive experience, one who works side by side with your employees, one who offers guidance and support, and one who provides top-tier service year after year, only one group can satisfy those criteria and exceed expectations: MetaStar. Reach out today for more information and to request a proposal.
* HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA). NCQA HEDIS Compliance Audit™ is a trademark of NCQA.