HEDIS® 2019: What You Need to Know

HEDIS® 2019 will be here before you know it! With that in mind, the DHS Group blog caught up with Shean Dalton to discuss how the DHS Group team can help answer all of your HEDIS questions and help you on the path for a successful reporting season. Shean is a member of the 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.

DHSG Blog: What are the most important things to keep in mind for successful HEDIS® reporting?

S. Dalton: There are three main things I would concentrate on…

1. Overall good project management practice, with emphasis on stakeholder communications. Beyond delivering a high quality of care, departments and practices need to know the specifications, time, and resource requirements to produce measured high quality. Knowing these and being aware of the cross-organizational integrations necessary, teams are enabled to implement systems and processes that bring to light existing high-quality performance.

2. Goal setting: HEDIS® is a long game. This is especially true for CMS’ Stars program and weighted measures. Many successful goals are formulated in collaborative environments. Discussing HEDIS® results with cross-functional subject experts raise the organizational awareness of enabling strengths and problematic weakness: elements of successful goal setting. These discussions also prepare the way for targeted initiatives. Ultimately, well informed key stakeholders empower change to achieve goals.

3. Data. HEDIS® is a quality measure based on data received from disparate data sources. Over the HEDIS® long game, this data is dynamic, constantly affected by change: IT systems, process model, people, and data schemas. Sustainable long-term high-quality results are only achievable by establishing high-quality data practices. Building quality into the data practices requires elevating the organization’s awareness of HEDIS® and establishing an interdepartmental sensitivity to how changes will impact HEDIS®.

DHSG Blog: With those three things in mind, what does DHS Group bring to the table to help clients through this journey?

S. Dalton: DHS Group has a long history in the marketplace as a key contributor in improving population health – specifically in Puerto Rico, Texas and New York. Not only does the team excel through the reporting process, pulling the data together in the best way possible to produce outstanding HEDIS® requirements, but also in helping plans that are new to HEDIS® - especially plans that have just realized that they need to do HEDIS®. Moving forward, the team is always ready to help mature plans take the next big step to improve rates they may have plateaued by applying our HEDIS® expertise and acuteness to data quality.


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, as a reporting community, 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, click here.