REWIND: Preparing for HEDIS Reporting Season

With HEDIS® 2018 just around the corner, our team caught up with Shean Dalton to refresh last year’s information on the HEDIS® reporting season and help you be best prepared for 2018. Shean is a member of DHS Group’s Health Plan Solutions team, a group that assists health plans with HEDIS® reporting, Medicaid, Medicare Part C & D and Exchange auditing with a focus on technology, experience and data integrity.

Dalton: For any size health plan preparing to enter the HEDIS® reporting season, three key topics to continually circulate within the organization are:


As the organization ramps back up from summer activities, it’s important to ensure that organizational leaders are aware and thinking about the approaching HEDIS® event horizon. Leaders should build and foster relationships with organizational stakeholders: listening for suggestions and ideas, while sharing early on what HEDIS® changes and new requirements are expected. Most importantly, leaders should have identified and communicated internal and external resource requirements for production, audit, reporting, and medical record review: including training.

When everyone involved is aware of what is needed from them, tuned into what their colleagues are working on, and planning for any integration necessary, the teams are able to implement systems and processes that showcase a business line’s high-quality performance.


Formulate the right goals, and avoid distractions. HEDIS® specifications are updated mid to late in the year, allowing little time to adapt in the current measurement year. CMS’ STARS revenues are based on years’ prior performance ratings, and, outcomes and satisfaction measures are weighted more than operation measures.  Departments wanting to support HEDIS®, may set goals only based on snapshots and not take into account all the complexities related to HEDIS®, Stars, and benchmarks:  leading to unexpected results.

Pull departments together, including subject experts, to discuss HEDIS® performance and measure changes. With everyone on the same page, the organization is best prepared to recognize strengths and weaknesses, as well as generate keen insights for leveraging existing processes to improve results. Follow up and develop roadmap goals that have the best potential to be achieved.

Well-informed stakeholders empower change to achieve goals.  


HEDIS® is a quality measure based on dynamic data that is received from disparate data sources. Consider elements of data management: volume, velocity, variety, variability, and veracity. Over the course of the measurement periods, data can reflect changes made to IT systems, process models, people, data schemas and more.

Be alert to the lasting and impactful results of data management on HEDIS®. Also, raise the organizational awareness and sensitivity for how changes the organization may make will impact HEDIS® and reporting functions. Get in front of the data change curve: especially, the growing reliance on electronic medical record data across more measures, and, necessity for additional provider information related to new opioid abuse measures. 

Looking for more information about successful reporting or have a question about getting started? Dalton, along with several other members of DHS’s Health Plan Solutions team, help host a LinkedIn Group dedicated to HEDIS® networking with the goal of improving the quality of care delivered across the U.S. and abroad. You can visit and join here.

To learn more about DHS Group’s Health Plan Solutions team and their long history in the market as key contributors to improving population health visit