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Points of Light 2024 Case Study 7
Closing Care Gaps for HEDIS Measures through Natural Language Processing
Author
Boyd Stewart
Author
Aurene Wilford
Accurate data is needed for HEDIS reporting, but claims data does not always provide payer and provider organizations with a complete picture of patient/member compliance with Medicaid measures. To mitigate this challenge, the stakeholders in this collaboration created a continuous HEDIS review workflow to triage cases and close care gaps. Outcomes include increased efficiency in identifying care gaps, fewer cases that need to be manually reviewed, and better patient/member care.
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Key Findings:
- Executive Summary
- The Collaborators
- Points of Friction—Challenges to Be Solved
- Action Plan—How the Collaborators Worked Together to Reduce Friction
- Points of Light—Outcomes Achieved through Collaboration
- Lessons Learned—What Best Practices Can Other Organizations Replicate?
- What's Next?—Vision for the Future
Writer
Natalie Hopkins
Designer
Jess Wallace-Simpson
Project Manager
Joel Sanchez
This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2024 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.