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    HEDIS and Performance Measurement

    TMG's HEDIS consultants have worked with a wide variety of Health Plans to improve HEDIS rates over the last 10 years. They have built long-term solutions that address the root cause of the problems. Some examples include initiatives to improve encounter data collection and provider report cards and incentive programs, and member outreach/incentive programs. These programs have resulted in significant improvements in a number of HEDIS measures over the years.


    Each of TMG's HEDIS consultants has at least 10 years of experience in health care and has worked in Medicare, Medicaid and Commercial plans at levels ranging from senior leadership to project managers. They are a diverse group with extensive experience in assessing and implementing projects to improve HEDIS and CAHPS rates and quality of care.

    TMG consultants facilitate the implementation of improved processes, resulting in enhanced data integrity and a reduction in error rates. Improved data quality, data integrity and data capture result in more informed decision-making and better management of organizational processes. Resources are more effectively deployed and rework (for example, data cleansing) is reduced.

    TMG's HEDIS team includes:

    • Analysts with over 10 years of experience in analyzing HEDIS, CAHPS, and HOS.
    • HEDIS leads and project managers with over 10 years of experience in managing HEDIS projects.
    • Technical experts with experience in using and enhancing a number of different HEDIS software applications.
    • Licensed registered nurses and certified coders with HEDIS medical record abstraction experience.
    • Information technology professionals with experience in assessing, programming, and developing system solutions.


    HEDIS consulting services are available to meet any HEDIS need from setting up HEDIS reporting and data collection services to sophisticated analysis to identify members most likely to affect ratings and applying robust interventions for this targeted population.

    TMG's HEDIS Team can:

    • Provide comprehensive analysis to identify HEDIS measures most likely to improve and provide maximum yield.
    • Develop customized monitoring tools to track HEDIS performance on an ongoing basis.
      • These tools can quantify the number of compliant records needed to meet pre-established thresholds.
      • Financial calculators built into the tools can show financial return by improving performance, if incentives are received.
    • Offer strategies to comply with audit requirements and ensure measures are reportable.
    • Show you how to improve data collection and increase performance overall and with specific partners such as laboratory vendors, vision vendors, contracted medical groups and independent physician associations.
    • Provide HEDIS audit and improvement solutions including:
      • Strategies for improving medical record pursuit. For example, data mining to identify leads, reviewing chase logic, and training abstraction staff on ways to abstract records efficiently.
      • Managing or supporting the HEDIS medical record pursuit process to meet established timelines.
    • Perform HEDIS in-season and off-season medical record retrieval activities for non-compliant members.
      • In-season and off-season medical record abstraction is conducted by certified abstractors according to HEDIS specifications.
      • Enter abstracted data into tools that meet requirements set by HEDIS technical specifications.
    • Enhance HEDIS software solutions by:
      • Providing proven solutions to monitor HEDIS rates on an ongoing basis.
      • Building physician and group level report cards and feedback reports.
      • Building real time HEDIS improvement calculators that identify the number of compliant records needed to achieve established targets.
      • Enhancing chase logic to improve abstraction efficiency and effectiveness.
    • Develop and implement proven interventions such as:
      • Strategies to improve member outreach and increase member auto enrollment including automated messaging, live calls, and innovative appointment scheduling strategies to increase the number of appointments scheduled for non-compliant members for specific HEDIS measures.
      • Quality improvement programs to improve specific measures.
      • Incentive programs for providers, members and staff.
      • Provider feedback reports and gaps-in-care reports to identify target populations.
      • Data collection improvement specific to claims, encounters, laboratory services and other supplemental sources.
    • Apply in-season HEDIS best practices including:
      • Identifying appropriate HEDIS vendors such as certified software vendors and medical record review vendors.
      • Data mining to identify potential leads for abstraction.
      • Improving administrative data collection and administrative rates to reduce sample size for medical record review.
      • Conducting thorough process reviews and mock audits to prepare for the final audit.
      • Project Management of all of in-season activities to ensure compliance with all NCQA timelines, including working with HEDIS vendors, internal staff and HEDIS auditors.

    For more information about TMG’s health care consulting services and products, please e-mail us or call (773) 929-4276.

    1300 W. Belmont · Suite 500 · Chicago, IL 60657 · 773-929-4276

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