The Quality Data Coordinators (QDC) are committed to identifying and closing gaps in care to facilitate quality patient care in accordance with Healthcare Effectiveness Data and Information Set (HEDIS). “The current HEDIS set addresses preventive services, chronic disease management, behavioral health care, appropriateness/overuse of services and value. HEDIS includes measures for high-burden diseases such as diabetes, asthma, heart disease and depression, as well as preventable hospitalizations and patient satisfaction.” http://www.ncqa.org/hedis-quality-measurement/hedis-measures/hedis-2017.
HEDIS measures address a broad range of important health issues such medication use for chronic conditions, cancer screenings, childhood, adolescent and adult immunizations, care of patients with chronic conditions, and safety and mental health screenings.
A “gap in care” is created when the insurer has not received a claim for certain tests or screenings related to chronic care management or disease prevention. The QDS team will review medical records to extract and submit pertinent data to close these gaps in care. If data cannot be found, the QDS team will identify patients who need intervention to close the gap and work with providers to order appropriate tests/screenings.