With HEDIS 2017 just around the corner, our team caught up with Shean Dalton to discuss three key topics to keep in mind while preparing for upcoming reporting season. Shean is a member of DHS Group’s Health Plan Services 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.

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

1. Project management
Ensure the whole organization is readied for the priority and continuity of improving HEDIS rates. HEDIS’s evolving needs often require extra processes and tailored information from departments that, when requested, could impact or change established departmental metrics. Late awareness of HEDIS requirements increases friction and resistance. Take action early with strong stakeholder communication, building project coordination for a successful adaptation.

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.

2. Goal setting & collaboration
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. 

3. Data
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. Additionally, raise 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.


Looking for more information about successful reporting or have a question about getting started? Dalton, along with several other members of DHS’ Health Plan Services team, co-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.

Follow the button below to learn more about DHS’s Health Plan Services team and their long history in the market as key contributors to improving population health.

HEDIS® is a registered trademark of The National Committee for Quality Assurance.